back from vets with no diagnosis- Syntigraphy-questions

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clairefeekerry1

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just come back from vets after lameness investigations. they still cant give me a diagnosis and now he has to be reffered to another equine hospital for scintigraphy. i am now gettig confused between all these scans and things. he is only lame when ridden (he is now horribly lame when ridden) and shows no response to bute he was nerve blockd on both legs today and no difference(this has been done twice now). he then had his feet,pasterns,fetlocks x rayed and they were very clean. one of his navicular bones looked slightly 'odd' to the vet, but not enough for a diagnosis and they thought it might just be the shape of the bone and it always had been like that, plus its not on the leg he is lame on. so they are really pushing for a bone scan. i've read my insurance policy and it says i am only covered 50% for MRI scans. is scintigraphy and MRI the same thing? what will it show? will it show muscle or soft tissue damage? the things the vet has said it could be are arthritis in the neck, DDFT damage or soft tissue damage or navicular. will scintigraphy confirm either way??????
also posted in NL
 
MRI is magnetic resonance imaging, which is almost a "photograph" of the structures which are being MRI'd. Think of it as very clear xrays that show soft tissue and bone clearly.

Gamma Ray Scintigraphy is where your horse is injected with a radioactive isotope. It then gets absorbed into whatever areas of the body are inflamed and they show up as "hot spots".

You can scintigraph a whole horse, wherease they usually MRI the feet and I don't think they can even do a whole horse!

But both cost an arm and a leg, around the £1000 mark.

If you MRI and the problem is in the area you MRI you'll probably get a diagnosis. If you Scintigraph you'll know where the horse in inflamed, if it is, but you won't necessarily know it's that causing the lameness.

Only lame when ridden, no response to bute, nothing on xrays of legs - surely points to the back, in the saddle region. Can they not do a spine xray first, which will be wholly covered by your insurance???
 
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cptrayes said:
MRI is magnetic resonance imaging, which is almost a "photograph" of the structures which are being MRI'd. Think of it as very clear xrays that show soft tissue and bone clearly.

Gamma Ray Scintigraphy is where your horse is injected with a radioactive isotope. It then gets absorbed into whatever areas of the body are inflamed and they show up as "hot spots".

You can scintigraph a whole horse, wherease they usually MRI the feet and I don't think they can even do a whole horse!

But both cost an arm and a leg, around the £1000 mark.

If you MRI and the problem is in the area you MRI you'll probably get a diagnosis. If you Scintigraph you'll know where the horse in inflamed, if it is, but you won't necessarily know it's that causing the lameness.

Only lame when ridden, no response to bute, nothing on xrays of legs - surely points to the back, in the saddle region. Can they not do a spine xray first, which will be wholly covered by your insurance???
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thank you for you reply. they haven't even suggested that?? someone said they are only trying to get more money out of me be sending him for bone scans. i'm worries they do all of that and it shows nothing. if they did bone scan him, would that show up any bits on his back or is it worth getting a chiro out first? i'm worried that his back hasn't really been mentioned by them now. they have had a good look at my saddle and agree all is well there. i have also had the saddle fiter out twice in the last 5 weeks who cant find any issue with it?
 
My daughters little horse had scintigraphy because nothing specific showed up on other investigations and it revealed something we were not looking for - a stress fracture to the stifle. It was fully covered by my insurance and as has been pointed out above addresses the whole horse - MRI is purely the lower leg.

Usually there are further targeted investigations needed as scintigraphy shows up inflammations literally as hot spots. Toby needed xrays to pin down why there was a red area in his stifle but at least it narrowed it all down from a fishing trip!!

They have to be in isolation for 24 hours I am afraid - no human contact other than observation from the door of a special stable. Obviously they are given enough feed etc to last and a nice deep bed.
 
Like cptrayes, I'm very interested by the "only when ridden" component of this situation. Do you mean he shows NO sign of unsoundness under any other circumstances - longeing, different surfaces etc.? Does it matter who is riding him? How long has he been lame and were there ANY loss of performance symptoms previously, no matter how apparently unrelated? What level/work was the horse doing before this all started? With the same people, wearing the same saddle etc.?

Sorry, I know you're just asking for advice on the tests but I'm really curious that if the ONLY common factor between his lameness episodes is being ridden, there's not been more aggressive investigation into those specific pressures. (I don't know if there has or hasn't been, hence my curiosity. :) ) The tests you mentioned may very well show up the trouble spot but surely there is a risk, if the problem is under saddle and the horse is not currently being ridden because he's lame, that the tests will be inconclusive because the damage is so specific? What do the vets say on the matter?
 
My last horse had syntigraphy to diagnose an odd lameness. Not only did it show up a fracture to the pelvis but Kissing spine and several bone cysts! Unfortunately there was too much to try and put right for my horse and he was PTS however, don't let this put you off as it is a good method of diagnosis and you should get some definite answers.
 
TarrSteps said:
Like cptrayes, I'm very interested by the "only when ridden" component of this situation. Do you mean he shows NO sign of unsoundness under any other circumstances - longeing, different surfaces etc.? Does it matter who is riding him? How long has he been lame and were there ANY loss of performance symptoms previously, no matter how apparently unrelated? What level/work was the horse doing before this all started? With the same people, wearing the same saddle etc.?

Sorry, I know you're just asking for advice on the tests but I'm really curious that if the ONLY common factor between his lameness episodes is being ridden, there's not been more aggressive investigation into those specific pressures. (I don't know if there has or hasn't been, hence my curiosity. :) ) The tests you mentioned may very well show up the trouble spot but surely there is a risk, if the problem is under saddle and the horse is not currently being ridden because he's lame, that the tests will be inconclusive because the damage is so specific? What do the vets say on the matter?
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hi, i'm desperate for some advice or ideas so i'll fire away!!

he appears pretty sound when lunged on hard and soft surface, felxion tested, trotted up. he looks ever so slightly short but they struggle to even put him at 1/10th lame unridden. had it all done again today and same thing, prob not even 1/10th lame. in fact he looked pretty darn good lunged on concrete today. i do sometimes notice a little bit of lameness when bringing in from field, but it is very minor.
he has been ridden by others (vet nurses etc) with same results, it is also mainly on the left rein and mainly in trot. it is now so bad he barley wants to move and is about 9/10th lame ridden on a 15m circle. its also like he is just saying i cant do this, he is hopping lame.
he was coming on amazingly well previous to this, working most days at higher level RC stuff, very fit. it started about 5 weeks ago when he would pop the odd lame stride in and its gone on from there. he is also not comfortable ridden downhill. he has always been prone to run outs when jumping but he has always done it.
his saddle fit has been reguarly checked by a very good saddler and i have recently got a new saddle although these lameness prob started before i got my new saddle. in fact i have hardly had a chance to use it!
i've had a physio out who said he was tight all over but nothing horrendus, oddly, he was sound for a week after the physio but it came back. vets think this may be as she treated some unrelated pain. i have asked if its his back and they have had a feel with nothing obvious but just say 'could be' which is there answer to everything at the moment.

i've had him 13 months, old owners did some higher level juping with him with no issues but i've probably concentrated more on his schooling.

i kinda just feel bone scanning is there answer to everything. i say could it be.... they say 'dont know'. his back hasn't really been mentioned, more focus on neck and foot.

any ideas... please!!
 
TicTac said:
My last horse had syntigraphy to diagnose an odd lameness. Not only did it show up a fracture to the pelvis but Kissing spine and several bone cysts! Unfortunately there was too much to try and put right for my horse and he was PTS however, don't let this put you off as it is a good method of diagnosis and you should get some definite answers.
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thats awful. tho i'd rather know than not and i have told myself that you dont get this far only to find out its something silly and simple. i have prepared myself to think to get to this stage it must be serious
 
Does he show anything with the saddle on, girth up tightly, but no rider? Is he comfortable being led/longed on a hill? Has he ever done xc and is he okay jumping off banks?

Bearing in mind I have not seen the horse so would only, at best, be guessing, I might wonder shoulder or some combination of shoulder and saddle. When he's been tried by other people, has it always been in your saddle?
 
TarrSteps said:
Does he show anything with the saddle on, girth up tightly, but no rider? Is he comfortable being led/longed on a hill? Has he ever done xc and is he okay jumping off banks?

Bearing in mind I have not seen the horse so would only, at best, be guessing, I might wonder shoulder or some combination of shoulder and saddle. When he's been tried by other people, has it always been in your saddle?
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he's been lunged and trotted up with full tack on but with no rider and wasn't as lame as when ridden but was 2 or 3 10ths lame. oddly, when we did this he seemed lamer on the other leg than the one he's lame on when ridden. he's done quite a bit off XC as cant remember him having any issues with banks (they wouldnt have been big tho) but he has always been prone to stops and run outs. whilst led down hill or lunged he seems to prefer keepng his head and neck low and whilst not head nodding lame seems like his leg sometimes jars if that makes sense. i always thought shoulder as he tripped badly down a rabit hole about 6 weeks ago so maybe thought he's pulled something in that area but how can that be diagnosed by a bone scan??? thats my concern. i have relayed this to the vets and again they say we'll send him for a bone scan.
he has always been tried in my saddle. he only thing we haven't tried is bareback

thank you so much for your comments, i am desperte to hear what other people think/suggest!x
 
Wow, how interesting this one is Sherlock!

He went lame, only when ridden, after tripping down a rabbit hole six weeks ago?????

Have they checked for a deep shoulder muscle injury??????? That would easily produce these results. OK, just about, without the weight of a saddle and rider on the shoulder, unsound with 10 or more stone on it.

To check, pick up his front leg with the elbow to knee parallel with the ground and the knee to foot trailing under its own weight. Then pull it steadily and gently but strongly (if you see what I mean, being prepared to stop at any time) sideways, out from his body and pull the foot further out from his body than his knee. Don't force anything! Watch his face and his ears and you'll see if, and where, it hurts. If it does, rest and physio are the only cure.

They don't usually test for this as it's an unusual injury because the shoulder is so well muscled, and not actually connected to the rest of the skeleton. It can produce unpredictable lamenesses.

Good luck, and let us know!
 
cptrayes said:
Wow, how interesting this one is Sherlock!

He went lame, only when ridden, after tripping down a rabbit hole six weeks ago?????

Have they checked for a deep shoulder muscle injury??????? That would easily produce these results. OK, just about, without the weight of a saddle and rider on the shoulder, unsound with 10 or more stone on it.

To check, pick up his front leg with the elbow to knee parallel with the ground and the knee to foot trailing under its own weight. Then pull it steadily and gently but strongly (if you see what I mean, being prepared to stop at any time) sideways, out from his body and pull the foot further out from his body than his knee. Don't force anything! Watch his face and his ears and you'll see if, and where, it hurts. If it does, rest and physio are the only cure.

They don't usually test for this as it's an unusual injury because the shoulder is so well muscled, and not actually connected to the rest of the skeleton. It can produce unpredictable lamenesses.

Good luck, and let us know!
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well i have done my own little tests (!) just pulling the leg out and we all agree he looks uncomfortable, grunting, ears back etc. i have told this to the vets and they said they'd like to send him for a bone scan as they seem to think its neck rather than shoulder. see my theory is if you got your leg stuck in a hole and tripped forward your muscles would be so sore, possibly even torn. that might also explain why he was sound after the physio for a week or so.i'm going to try your test tomorrow. thanks.
 
sorry to throw another option in the midst but have you thought about getting a thermographer out, they aren't that expensive and it should tell you where there is more pain when both ridden and not ridden.
at least then you should have a better idea of the area you are looking at and then you can pass the results back to your vets.

i've not had one done on my horses (although am interested) and i don't have any other ideas as to what could be wrong apart from agreeing with what others have said.
good luck and hope you get an answer soon.
 
clairefeekerry1 said:
well i have done my own little tests (!) just pulling the leg out and we all agree he looks uncomfortable, grunting, ears back etc. i have told this to the vets and they said they'd like to send him for a bone scan as they seem to think its neck rather than shoulder. see my theory is if you got your leg stuck in a hole and tripped forward your muscles would be so sore, possibly even torn. that might also explain why he was sound after the physio for a week or so.i'm going to try your test tomorrow. thanks.
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I completely follow your logic! If it is what we think, then he may hop the other foot off the floor to stop you lifting his shoulder too far out from his body. The grunting and ears seem like a bit of a giveaway to me. Far too early to talk about bone scanning, anyway!

Mine did this type of injury jumping the barbed wire fence at right angles to the sheep hurdle that I had him pointing at, and landing heavy on one foot on tarmac. He was oddly and intermittently "can't put my finger on it" lame. My vet found it when vetting him to sell. It only took a couple of weeks rest and some gentle build up back to full work and he was fine.

A friend's horse did a more minor tear by slipping on a slope in mud messing about in the field. In her case, she could feel the inflammation by running her hand "inside" his shoulder blade. On one side she could get her fingers slightly behind it from top to bottom. On the other, there was a block close to the top where her fingers would not go in. You could do that test tomorrow too.

The physio could easily have broken an adhesion that was making him sore when he moved. Then that adhesion, or another, formed again and he is lame again. He may need ongoing physio sessions (you can be taught them) for a while until all possibility of adhesions forming from the inflammation is over.

Do let us know what you found Sherlock :)
 
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I can understand why Vets wouldnt be to keen on thermography, i recently had my whole horse done & it did show up things. However the horse was then Bone Scanned with nothing found in any of the area's that where pointed out in the Thermography.
Horse was then MRI'd & the cause was found but again it didnt show up in the Thermography.
I was also told the horse had Acute damage to a ligament on the opposite leg to the one that the horse went lame on by the Thermography people. This wasnt found on the MRI.

The Vets i used at Leahurst didnt really want to know the Thermography results but they did read the report, however with what we found it kind of made a mockery of the thermolagy report.

Bone scans are great for ruling out fractures & other things bone related, but if it's not Bone related then other tests would need to be done. ive recently spent 3k on doing all these tests thank god insurance has now paid most of it.

Sorry if ive missed it but has the horse been rested ie, box rested at all?
 
he's had about 2 weeks off now and no different, but as he's only lame when ridden its difficult to tell!

my insurance will only cover 50% of an MRI scan so want to avoid that if possible. i'm worried that he goes in for bone scanning and it shows nothing. not sure where to go from there.
 
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