Bilateral hind limb lameness - best way to diagnose problem

B

Bangagin

Well-Known Member
Joined
6 July 2006
Messages
391
Location
Essex
Visit site
Looking for experiences and opinions please. Vet came out few days ago and diagnosed bilateral hind limb lameness, worse on off hind. My mare is only 5 and very straight hocked. My equine physio feels that the problem is in her stifle (she only diagnosed right hind lameness) with crepitus coming from this joint and she felt it lock a couple of times. Also her pelvis is asymmetric.

The vet gave two options re investigation - lameness work up at their practice or a referral to a vet hospital for bone scan to show up "hot spots" of inflammation. I am not covered on insurance for these investigations, so cost is an issue - and my vet felt that the cost would be similar for both options.

I'm finding it very difficult to decide between the two. She is not covered on insurance for these investigations - I have a reasonable amount of savings and a private pension that is about to mature in January, but obviously this is just the diagnosis so I want to keep the cost as low as possible.

I've had a few opinions in a FB group for stifle lameness and just wanted to ask on here for everyone's experiences/thoughts. Think I will then make a decision based on majority. Thanks in advance everyone.
 
Bangagin said:
Looking for experiences and opinions please. Vet came out few days ago and diagnosed bilateral hind limb lameness, worse on off hind. My mare is only 5 and very straight hocked. My equine physio feels that the problem is in her stifle (she only diagnosed right hind lameness) with crepitus coming from this joint and she felt it lock a couple of times. Also her pelvis is asymmetric.

The vet gave two options re investigation - lameness work up at their practice or a referral to a vet hospital for bone scan to show up "hot spots" of inflammation. I am not covered on insurance for these investigations, so cost is an issue - and my vet felt that the cost would be similar for both options.

I'm finding it very difficult to decide between the two. She is not covered on insurance for these investigations - I have a reasonable amount of savings and a private pension that is about to mature in January, but obviously this is just the diagnosis so I want to keep the cost as low as possible.

I've had a few opinions in a FB group for stifle lameness and just wanted to ask on here for everyone's experiences/thoughts. Think I will then make a decision based on majority. Thanks in advance everyone.
Click to expand...
I'd personally go with the lameness work up and then whatever their findings they can hopefully treat there and then and you can get a physio on board too, when you've seen a vet. .

Whilst a bone scan can be a quicker diagnosis maybe, I've heard it's not that useful with stifles. https://pubmed.ncbi.nlm.nih.gov/25065687/

I have no personal experience with either method for stifles. Good luck for your girl.
 
Last edited:

Stifle issue in my 4 year old cob

Hi everyone, hope you can help with some advice here. I bought a four year old cob from Ireland who had had vetted ( 5 star but it wasn't nearly as expensive as a UK one...so not sure it would have been as thorough). He passed and I was delighted...he arrived on the 23rd August...was in...
forums.horseandhound.co.uk forums.horseandhound.co.uk

There is a similar thread on here at the moment might be worth you reading
 
Conventional lameness workup first, and IME that would be a lot cheaper than a bone scan.

My equine vet is now of the opinion that a bone scan is not the wonder diagnostic tool that it was initially hoped that it would be. She talked me out of getting one done.

If the lameness blocks just to the stifle, then at least you know where to look further if you decide to investigate. Stifle lamenesses can be quite tricky.

As she is already both straight behind and has an existing asymmetric pelvis I think that you must be prepared for her to be not to be able to stand much ridden work 😬.

Good luck anyway.
 
Birker2020 said:

Stifle issue in my 4 year old cob

Hi everyone, hope you can help with some advice here. I bought a four year old cob from Ireland who had had vetted ( 5 star but it wasn't nearly as expensive as a UK one...so not sure it would have been as thorough). He passed and I was delighted...he arrived on the 23rd August...was in...
forums.horseandhound.co.uk forums.horseandhound.co.uk

There is a similar thread on here at the moment might be worth you reading
Click to expand...
I have read that thread thank you - it was the fact that the bone scan proved inconclusive that prompted me to ask a wider audience what they felt was the best route for diagnosing.
 
U.N.Owen said:
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
Click to expand...
She didn't offer any information on what she suspected it to be - and for my own peace of mind I need to try to find out where the problem lies.
 
Tiddlypom said:
Conventional lameness workup first, and IME that would be a lot cheaper than a bone scan.

My equine vet is now of the opinion that a bone scan is not the wonder diagnostic tool that it was initially hoped that it would be. She talked me out of getting one done.

If the lameness blocks just to the stifle, then at least you know where to look further if you decide to investigate. Stifle lamenesses can be quite tricky.

As she is already both straight behind and has an existing asymmetric pelvis I think that you must be prepared for her to be not to be able to stand much ridden work 😬.

Good luck anyway.
Click to expand...
Yes I'm not very hopeful re ridden work. I only want a bit of light hacking, but preferably more than walking everywhere. The main thing is for her to be as comfortable as possible.
 
Personally I would go to the referral hospital for an evaluation, then depending on that +/- bone scan/work up. In my experience local practices can wrack up huge bills by spending smaller amounts over multiple visits and then end up referring anyway. Also the specialists may take one look and say in their experience whether it is worth persevering bearing in mind that it sounds like it may be conformational/chronic. It sounds harsh but you may need to think how much your going to throw at an unproven young horse.
 
Go straight to the vet hospital, they should be able to do the lameness work up there…then they are on site if any further investigations are needed? That’s what we did with my horse, didn’t bother getting him assessed at home
 
Easy decision made for me now. Estimate from vet hospital is almost £3500 - so £2000 more than my vet estimated. Still reeling from that to be honest as it's so far out.
 
I spent a fortune of my insurance company’s money investigating what turned out to be stifle lameness with a grade 4 meniscus tear.

The treatment was box rest, followed by building up in-hand walking with small pen turnout along the way, building up to full turnout and 40m in hand walk in and then getting back on after 3 months. I then spent the winter walking her building up to an hour 3 times a week and plenty of turnout. She’s been sound for 2 years now - we mostly hack 2-3 times a week but in all paces and she has a lesson a couple of times a month including polework. She’d probably cope with more but honestly it’s enough for me.

So you could just get a rehab plan from the vet and see how she goes.

The only issue would be if it’s something like a bone chip that is better removed.
 
Last year one of mine went for a hind-limb lameness work-up at my vets which is also a hospital. The full work up cost over £2000 inc. 2 nights stay. I opted for nerve blocks and didn’t have bone scans because often you still need nerve blocks anyway. If source high up though it’s much harder to block. They recommended tenoscopy / annular ligament surgery on both hinds but I decided not to go ahead as thought the cost of surgery would be in excess of my insurance given how much just the work-up cost with an unknown outcome. Plus some doubts about whether it was the main or only issue. He’s an older horse though who I will just happy hack as long as he’s comfortable and fully retire if not.
 
WestCoast said:
I spent a fortune of my insurance company’s money investigating what turned out to be stifle lameness with a grade 4 meniscus tear.

The treatment was box rest, followed by building up in-hand walking with small pen turnout along the way, building up to full turnout and 40m in hand walk in and then getting back on after 3 months. I then spent the winter walking her building up to an hour 3 times a week and plenty of turnout. She’s been sound for 2 years now - we mostly hack 2-3 times a week but in all paces and she has a lesson a couple of times a month including polework. She’d probably cope with more but honestly it’s enough for me.

So you could just get a rehab plan from the vet and see how she goes.

The only issue would be if it’s something like a bone chip that is better removed.
Click to expand...
Yes my physio has tried several treatments but felt a vet referral was necessary as there was little improvement after several sessions so she felt there may be more going on in her joints.
 
much as it can be useful (and sometimes cheaper) to head straight to referral practice it sounds like she's had no work up so far so straight to bone scan would be a big leap when you know 1) it is in the hind end, 2) not even nerve blocked/scanned suspensories or xrayed anything.
 
Have you shopped around? For anything mechanical I take mine to a larger vet hospital than my own vets, it's considerably cheaper (being one of the few independent practices). I can stay and watch and be involved in any decisions, unlike my own vets' hospital where I have to drop the horse off and don't have any further involvement until it comes to paying the bill! It's further away, but worth it for the price difference, plus I find it really interesting to watch the investigations and listen to the vet's opinion on each one.
 
Hackback said:
Have you shopped around? For anything mechanical I take mine to a larger vet hospital than my own vets, it's considerably cheaper (being one of the few independent practices). I can stay and watch and be involved in any decisions, unlike my own vets' hospital where I have to drop the horse off and don't have any further involvement until it comes to paying the bill! It's further away, but worth it for the price difference, plus I find it really interesting to watch the investigations and listen to the vet's opinion on each one.
Click to expand...
The quote was from Newmarket Equine Hospital - not my vet practice.
 
Bangagin said:
The quote was from Newmarket Equine Hospital - not my vet practice.
Click to expand...

They aren’t cheap being a large hospital. I agree with others, shop around. Ask horsey people in the area who they recommend.

I’d go for a lameness work up, nerve blocks and X-rays (maybe ultrasound if stifle suspected) and see what they say. I wouldn’t go for a bone scan quite yet.

In September my mare had a extensive lameness work up by a lameness vet. £150 for the lameness work up, nerve blocks were £150 per block and ultra sounds which was about £400 for all suspensories, neck, back and stifles. We didn’t xray as she’s had everything X-rayed previously.
 
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.
 
Tiddlypom said:
Conventional lameness workup first, and IME that would be a lot cheaper than a bone scan.

My equine vet is now of the opinion that a bone scan is not the wonder diagnostic tool that it was initially hoped that it would be. She talked me out of getting one done.

If the lameness blocks just to the stifle, then at least you know where to look further if you decide to investigate. Stifle lamenesses can be quite tricky.

As she is already both straight behind and has an existing asymmetric pelvis I think that you must be prepared for her to be not to be able to stand much ridden work 😬.

Good luck anyway.
Click to expand...
This.i had a bone scan done on my TB and it actually showed nothing really. Bit of a bit spot in one place but then x raying that showed not a lot. We medicated anyway and it did absolutely nothing. Mine was insured but I’d have been annoyed had a paid £0000’s and been no further forward. I’d thought going into it that the bone scan would have given a definite area even if it proved un treatable so was a bit gutted at having wasted the money.
 
Given the vast cost of a work-up and that you are paying not insurance, I would be tempted to rule out obvious candidates first. Nerve blocks don’t cost a fortune and you can then scan/x-ray as needed. Hocks are common, are bilateral, are a relatively inexpensive yes/no for example.
 
Tiddlypom said:
The £3500 is just for the bone scan, not for any lameness workup. Rather baffled why the vets have suggested the bone scan at this stage.
Click to expand...
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.
 
You must log in or register to reply here.
Top