Bilateral hind limb lameness - best way to diagnose problem

[IrishMilo]

A full lameness workup might not be as costly as you're expecting and it's definitely the option I'd go with. One of mine had a full work up last year and it was a lot less than what I was expecting. I got neck, knees, hocks, and feet done.

 

[ester]

Typical of vets though don't you think?
The other week with Lari's kick they were offering me scans, xrays and potential surgical input

It always seems that vets have to promote every option these Fridays no matter how expensive or wild they might be.

Except it’s the local vet suggesting referral for a bone scan instead of them doing a work up for it so no.

I absolutely want my vet to suggest all options so I can make an informed decision of how to proceed with any of my animals.

 

[Tiddlypom]

Lari’s kick injury looked really nasty. I think that you’ve posted since that it’s healing up nicely, which is great, but the vet was right to offer other options, especially the X-ray , as there could still be a stable fracture lurking there.

 

[Bangagin]

Just as an aside and for context, it's high possible or even likely that there's some kind of early life trauma that led to the asymmetric pelvis, and that that then causes compensatory movement and that the straight hind leg comes from that.

As a very general pointer a low set tail may mean the pelvis is slightly stuck in posterior tilt (ie the top is further back than it should be), often coupled with dips in the spine around the sacrum/si, there will flexion in the hip joint but the others will be straight (think I have that the same ight way round!).

If in anterior tilt, with a high set tail, then all HQ joints are pulled straight. Hamstrings can be an issue with both, but suffice to say most hind legs straightness is at least partially or substantially postural.

For sure find the acute joints and treat, but looking at it from a posture and movement point of view (which often means moving away from your own vet's paradigm, and sometimes even to a different bodyworkers) may open up other options as you move forwards.

Good luck.

I tend to always go down the route of consulting my equine physio in the first instance. What is rather confusing is that she came out when I first got Molly in May (I routinely get dentist/farrier/physio etc for any new horse) and there were no real issues noted apart from her being croup high, crepitus right hock and creaky medial stifles. But then I started ridden work and she found trot work difficult and particularly uphill work even in walk. At this point the asymmetry seemed to be picked up - not previously.

On trying her (before I bought her) I took her for a hack and did loads of trotting and she was really forward - that's why I liked her so much! Yes she could have been on bute - but I didn't actually go to try her - I went to try a gelding but didn't really click with him. So the seller was not expecting me to try her that day. I will never know for sure as bloods weren't taken, but she was a completely different pony when I got on her a month later (took that long to sort a saddle!).

I'm wondering whether another body worker might be useful as a second opinion. My friend uses one who has a thermal imaging camera so not sure how helpful that would be? For this the horse/pony needs to be stabled for 3 hours before treatment and I'm not sure Molly would cope with that as she is used to living out with a shelter so she can come and go as she pleases.

 

[Landcruiser]

Typical of vets though don't you think?
The other week with Lari's kick they were offering me scans, xrays and potential surgical input

It always seems that vets have to promote every option these Fridays no matter how expensive or wild they might be.

And the next client complains that they were given painkillers and sent on their way, and never offered the scans, X rays or surgical input that may have helped their animal.

 

[sbloom]

I tend to always go down the route of consulting my equine physio in the first instance. What is rather confusing is that she came out when I first got Molly in May (I routinely get dentist/farrier/physio etc for any new horse) and there were no real issues noted apart from her being croup high, crepitus right hock and creaky medial stifles. But then I started ridden work and she found trot work difficult and particularly uphill work even in walk. At this point the asymmetry seemed to be picked up - not previously.

On trying her (before I bought her) I took her for a hack and did loads of trotting and she was really forward - that's why I liked her so much! Yes she could have been on bute - but I didn't actually go to try her - I went to try a gelding but didn't really click with him. So the seller was not expecting me to try her that day. I will never know for sure as bloods weren't taken, but she was a completely different pony when I got on her a month later (took that long to sort a saddle!).

I'm wondering whether another body worker might be useful as a second opinion. My friend uses one who has a thermal imaging camera so not sure how helpful that would be? For this the horse/pony needs to be stabled for 3 hours before treatment and I'm not sure Molly would cope with that as she is used to living out with a shelter so she can come and go as she pleases.

Being croup high can be challenging in itself, without other issues. Have a look at the pelvic angle and see what you can find out. Yasmin Stuart has a great course on training the eye, but equitopiacenter.com is cheap and has a lot of resources to help you assess your horse, and a lot of introductions to some really good groundwork practitioners (though I mostly recommend Annie Dillon, Diana Waters and Patrick King). I think it's really good to educate your eye as much as you possibly can, for static assessments and for movement/lameness. So many horses are in compensatory movement patterns and are stuck, not so much with poor conformation (eg post legged behind) but bodies that are struggling and that are causing the apparent conformation issues through how they hold themselves. A very simple one is observing daily how they prefer to stand. Legs should be vertical from the sides and from the front/back - it's the only way the stay mechanism truly works, and if that isn't working that I don't think people realise how much muscle horses are using just to stay standing up.

Forward - can be running. It's very hard to know the difference, especially on a horse that's new to you. They may be running from saddle pain, or from bodily pain, if they're running. Horses naturally "fall forwards" (a much better expression than on the forehand IMO) and we only make that worse when we sit on them, unless we've educated them, helped them to find their own balance. Only then, controlling the HQs to start to reduce the amount the fall forwards, can we start to help them move better and straighter.

A thermal imaging camera can help pinpoint problem areas (but those can be damage OR active healing) but not to diagnose but not if it will cause her unnecessary stress. I would consider another bodyworker, but I really would encourage you to learn and assess her yourself, the more we know the more we can assess our professionals and make the best decisions on our horses' behalves.

 

[TheMule]

Typical of vets though don't you think?
The other week with Lari's kick they were offering me scans, xrays and potential surgical input

It always seems that vets have to promote every option these Fridays no matter how expensive or wild they might be.

The vet's job is to offer you the best treatment option for your horse. The gold standard of lameness investigation would be a full work up with nerve blocks, x-rays, ultrasounds and a bone scan (and perhaps MRI, depending on finding)

Presumably your horse had a kick in a potentially very serious place which could have been fractured or done significant soft tissue damage, If you're happy to manage conservatively then that’s fine, you take the risk. If you wanted to be sure then you could pursue further diagnostics. As some owners would do. My OH is a vet. If he goes to a potential fracture then he will advise x-rays, with a discussion around what that might show and any potential treatment options such as surgery. He's not doing it to make money. He's not doing it because he doesn’t know how expensive it may be. He's doing it because it would be the right choice for some horses and owners.

 

[BronsonNutter]

A full lameness workup might not be as costly as you're expecting and it's definitely the option I'd go with. One of mine had a full work up last year and it was a lot less than what I was expecting. I got neck, knees, hocks, and feet done.


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This isn’t for a full lameness work up/nerve blocks though - either that or your vet has done you a massive favour bill wise!

OP - if you wish to investigate your horses lameness I would suggest nerve blocking (and then imaging based on that) over bone scanning, given that you already have a query over stifles, and saying that your horse has quite straight conformation behind - which leads to a higher risk of suspensory inflammation. As lots of stifle issues can be soft tissue related (with it being the equivalent to our knee) they may not light up on a bone scan, and neither do most suspensory issues. So there is a risk that the bone scan might not give you any answers. I hope that helps, and that it’s something manageable for your horse.

 

[ester]

Afaik there’s still a dye shortage for bone scanning atm so regardless of anything else you’d likely be waiting a while anyway

 

[fredflop]

If you do get another body worker I’m I’d suggest someone like Rob Jackson, the horseback vet

 

[Bangagin]

This isn’t for a full lameness work up/nerve blocks though - either that or your vet has done you a massive favour bill wise!

OP - if you wish to investigate your horses lameness I would suggest nerve blocking (and then imaging based on that) over bone scanning, given that you already have a query over stifles, and saying that your horse has quite straight conformation behind - which leads to a higher risk of suspensory inflammation. As lots of stifle issues can be soft tissue related (with it being the equivalent to our knee) they may not light up on a bone scan, and neither do most suspensory issues. So there is a risk that the bone scan might not give you any answers. I hope that helps, and that it’s something manageable for your horse.

Thank you - this is the option I have decided to go for.

 

[MidChristmasCrisis]

My mare is going through lameness investigation….nerve blocked in various places up the hind leg, X-rays of pelvis, ultrasounds and finally a bone scan of hind end. So far I’ve spent approx 3k on the tests at two different horsepitals…and no diagnosis or solution found yet. However my farrier said he took one of his mares to a place where sensors were attached to all four legs and the pattern of movement was analysed and she had modified shoes on one hind leg and all the unbalanced movement resolved over time. I don’t know what the sensor investigation is called.

 

[dapple_grey]

However my farrier said he took one of his mares to a place where sensors were attached to all four legs and the pattern of movement was analysed and she had modified shoes on one hind leg and all the unbalanced movement resolved over time. I don’t know what the sensor investigation is called.

Sounds like an Equinosis? Very good piece of equipment and have used it on my horse. The vet brings it to our yard, the computer analyses all the information and gives a detailed report.

 

[Bangagin]

Just wanted to follow up on this for everyone who gave me advice. I decided to go for a full lameness work up with a different vet, and 5 weeks ago my mare went for a full lameness work up. When trotted up initially she was 2/10 lame, and after nerve blocks and x-rays and it turned out that the lameness was in her right hock. She had both hocks medicated, and was checked again last week and pronounced completely sound! So at a fraction of the cost of a bone scan I now have my mare back in work and am so happy that it wasn't anything more serious. (Well I know it's not ideal for a five year old to have problems, but in the grand scheme of things it was straightforward as we all know how things can go hugely wrong with horses!)

 

[ester]

Thanks for updating

 

[Birker2020]

Just wanted to follow up on this for everyone who gave me advice. I decided to go for a full lameness work up with a different vet, and 5 weeks ago my mare went for a full lameness work up. When trotted up initially she was 2/10 lame, and after nerve blocks and x-rays and it turned out that the lameness was in her right hock. She had both hocks medicated, and was checked again last week and pronounced completely sound! So at a fraction of the cost of a bone scan I now have my mare back in work and am so happy that it wasn't anything more serious. (Well I know it's not ideal for a five year old to have problems, but in the grand scheme of things it was straightforward as we all know how things can go hugely wrong with horses!)

So pleased for you! Much better than stifle issues.

Just keep an eye on what surface you ride her on and get her turned out as much as possible with a regular shoeing schedule and you'll be well away.

 

[anglo]

If you're not insured I would ask the vet what the treatment options would be for what things he suspects it to be and if they are similar just do that. Ie box rest and anti-inflamitaries and then time in the field etc

I did exactly that . An MRI was required to narrow down the injury site and when I asked my vet what treatment would be for the possible causes, it was the same treatment. I chose to spend the money on the treatments instead of the MRI, as all the MRI would do , would be pinpoint exactly where the injury was.

 

[KatieDM]

Just wanted to follow up on this for everyone who gave me advice. I decided to go for a full lameness work up with a different vet, and 5 weeks ago my mare went for a full lameness work up. When trotted up initially she was 2/10 lame, and after nerve blocks and x-rays and it turned out that the lameness was in her right hock. She had both hocks medicated, and was checked again last week and pronounced completely sound! So at a fraction of the cost of a bone scan I now have my mare back in work and am so happy that it wasn't anything more serious. (Well I know it's not ideal for a five year old to have problems, but in the grand scheme of things it was straightforward as we all know how things can go hugely wrong with horses!)

Great update. Can I ask what the cost was?

 

[Bangagin]

So pleased for you! Much better than stifle issues.

Just keep an eye on what surface you ride her on and get her turned out as much as possible with a regular shoeing schedule and you'll be well away.

Thank you. I'm very happy. She lives out 24/7 on a track (to help with her weight as she's a very good do-er) and has regular trims. She feels great so far!

 

[Bangagin]

Great update. Can I ask what the cost was?

It was just over £1400 for the lameness work up, nerve blocks, x-rays and joint medication. She was admitted first thing on the Monday, and was home lunchtime on the Wednesday.

 

[KatieDM]

It was just over £1400 for the lameness work up, nerve blocks, x-rays and joint medication. She was admitted first thing on the Monday, and was home lunchtime on the Wednesday.

Thank you! Just interesting to know these things.