Bilateral hindlimb lameness; what to do next?

alsxx

alsxx

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Currently debating how best to proceed with my boys lameness investigation.

Bit of background - mid June suddenly hit the brakes whilst schooling; could barely keep him in trot never mind canter, and completely stopped working through. Seemed ok on a couple if hacks out following but was given a couple of weeks rest in the field. No obvious lameness although I felt he wasn't right from behind.

Came back seemingly fine (although didn't bother trying to school at that point), and after a couple of weeks suddenly went 'lame'. Showed itself out in a hack; about half way round our route he suddenly developed a really odd gait in walk - almost dipping his quarters and crabbing to the right; had the effect of twisting my torso in the saddle. He felt perfectly normal in trot, but I got off and led him home.

Went to vets for workup two weeks later (after spending further couple of weeks in field looking decidedly not right but not conventionally lame - quarters to the right and almost swinging right hind out as he brought it through).

He was positive to flexion on both hinds, and positive to block to right hock. They also blocked left hock at the same time which made barely any difference and then had upper suspensory branch blocked again no difference. Whilst he looked better on the lunge following the block, when I got on to ride he felt worse than ever. He was pretty tired by that point, but he felt totally uncoordinated and I couldn't get a nice moment out of him. I said all of this to the vets who agreed he looked awful but suggested as he had some time off work and list muscle tone he was 'unfit'. I took this onboard but it wasn't until later that I thought, hang on - he had four months off last year due to me preparing for my wedding, being away etc, yet came back absolutely fine.

The conclusion from the workup was right hock spavin plus an intermittent lameness on the left hind that would probably need further investigation. He had the hock medicated two weeks later (I was on holiday in between) and was told to get him back up to normal work levels ASAP and see what happens.

He felt great for just under a week; work consisted of hacking mostly in walk with some trot and I started off with a shorter distance and built it up over a few days. Then the same problem reappeared; half way round a hack he suddenly developed the uncoordinated walk. Since then he's been in the field and has been going for some gentle in hand walks. I've popped on a couple of times and ridden a mile down the lane and back and he feels fine sometimes and then sometimes goes uncoordinated again.

Spoke to vet who seemed a bit flummoxed. The suggestion is he goes back next week for a further work up but vet wants to re medicate the hock the day before in the hope it will resolve the hock for the following days workup. I agreed but now I'm wondering what is the point? I can't see how it will suddenly make the hock pain free so quickly and I'm not overly keen in pumping him full of steroids for the sake of it (he's a TB but went down with mild laminitis mid winter). No X-rays were taken so is it possible to be conclusive that it is a bone spavin, or could it be a soft tissue injury?

Talked about maybe doing a bone scan, which I'm fine with, but I'm starting to wonder what we are going to achieve next week doing another workup? Vet doesn't think back is likely as he was fine to be poked and prodded and had no tightness in the back.

Confused!! Thoughts anyone??
 
The few horses I have known that have been treated for spavins have all required physio treatment along with medication, the physio has had to resolve problems further up the quarters and back caused by the horse holding itself to relieve hock pain. In fact two were only recognised as being bilaterally lame because the physio , who was treating for back pain, saw that they did not respond to treatment as they should and referred them back to the vet.

So I would get a physio to look at the horse, most will work to release tension that has built up during the period prior to diagnosis. They will then work with the vet to help get the horse more comfortable, just because there is no obvious sore area does not mean there is no problem in the muscles.
 
go for the scan/mri it will tell you what you need to know, I always think these sorts of lameness, nothing obvious, on/off sort of thing is probably deep seated and will only be found by looking inside as it were. My boy was the same just not quite right mri found a tear in the ddft in the offside rear hind, would not have found it without the mri, find what it is then you can sort out the treatment, until you know what it is you will be in the dark and not know if you are doing the right thing. Vet should recommend this for the insurance, mine did he said he could not reach full diagnosis without an mri.
 
Hi, thought I'd drop a post as I'm Kent based and I have a fab chiro/physio who I can recommend if you need one although I don't know which part of kent you are in, but she is very well qualified and vey experienced.

My horse had KS 6yrs ago, was operated on and has been doing well ever since, his KS showed up though gait not back, your vet seem to be going a fairly long way around things, hopefully with good reason?????? I have known this lady for years and use her regularly for check ups and if he has a stiff moment or just doesn't feel quite right. She is great at getting to the bottom of little niggles and she will also involve the vet straight away rather than treat something she knows she can't help with.

My vets are Bell Equine who know her and she is called Tess Dorrington. If you want her tel no let me know but I am hopelessly over protective of my horse and trust her implicitly, I find her a good sounding board if I am worried, but I also agree with the other replies about the scan, from reading your post the vet seems to think it is hock but you sound unconvinced. Tess looked at my friends horse, just knew it was a hock problem, she didn't treat it, but told her to call the vet straight away and he was diagnosed quickly with spavin and mild front arthritus in his front feet, a fresh pair of eyes can sometimes help and a scan should give you a definite diagnosis to work from.
 
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I agree with others re the bone scan. I think your boy needs further investigations. However, I would also urge you to get him tested for cushings and insulin resistance as developing laminitis in the middle of winter is a classic symptom of this. If he has cushings then it will make any condition he is suffering from much harder for him. Good luck. I hope you find an answer and get him right.
 
Thanks for all the replies!

Be Positive - I agree re the physio, and this is definitely something I will be asking for, however would like to look at this once we know what the other issue is.

NooNoo and Beth - yes it does sound like we are approaching things in a rather long winded fashion, however I wasn't sure if I was being 'difficult' thinking this and wanting to phone vets back to question it - I appreciate looking at him again so the vets can see how he is moving now, but just don't really see the point of doing more nerve blocks etc (he's not the best candidate anyway!!), or medicating the joint again if it potentially didn't work the first time (I assuming not, but what I feel may be the result of the other issue and the medication did work....who knows!).

Beth - I suspect he will either need referring to Bell or Liphook depending on costs; we are near Sevenoaks! Thank you for the recommendation though, I will certainly bear that in mind once we get to that stage.

Wagtail - he's been tested for cushings and insulin resistance, and both negative. Absolute pain not having the verification of a test to confirm my neurotic caution regarding his grass intake!!!!
 
alsxx said:
Beth - I suspect he will either need referring to Bell or Liphook depending on costs; we are near Sevenoaks! Thank you for the recommendation though, I will certainly bear that in mind once we get to that stage.
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See if you can get a referral to Bell and get David Sinclair to look at him. I was so impressed when my horse went there a few months ago for a lameness work up for a similar problem, in our case it was bilateral bone spavin.

The thing about having the hocks injected and working the horse to encourage fusion, is that your horse will need some pain relief during the initial stages.

But best to get a thorough work up done, as you don't want to be working the horse if it turns out to be something completely different.
 
Just to say I am near Sevenoaks too and brightmount is right David Sinclair who is one of the senior partners there is fab, if my horse is in trouble he is the one I would want to look at him - it's thanks to Bell that my boy wasn't put down as a 6yr old, can't recommend them enough and have been dealing with them for about 15yrs now!

David is very straightforward and will tell you honestly what he thinks, Bell are also extremely good at the day to day stuff as well as having all the scanning equipment, they put a very human face on absolutely horrible moments and will always do their utmost for you. I wouldn't want to use anyone else.

Good luck and let us know how u get on, I hope it gets sorted for you
 
Thanks for the recommendation. I'm currently waiting for vet to call to discuss next weeks planned workup and the possibility of moving straight to a scan.

I'm not overly concerned about the bone spavin (assuming that's correct and he has that plus something else), its the unknown that worries me. I will let you know how we get on! Xx
 
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