Difficult lameness diagnosis. Advice please!

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Ellie26200

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Hi all,

I am writing in desperate need to try and find out what is wrong with my horse. Was wondering if anyone out there has experienced something similar and could offer some advice, as me and the vet are both pretty clueless..

I bought him end of Jan, he’s an 8yo thoroughbred (had raced 7 times in early life)
I had a hunch that he lame a few months back but everyone told me he was fine and I was sure it was just me being paranoid. In the last month I have noticed it more and decided to get the vet out.

It turns out he was lame on the left foreleg and a little on the right foreleg as well (not as worse as the left). This could be seen more apparently on the lunge on a hard surface.

The vet did nerve block tests in the pastern, behind the fetlock, below the knee (half way up lower leg) and in suspensory ligament. Nothing improved the lameness. We then did X-rays of the fetlock and hoof (including navicular). Vet said everything looked perfect. Also did knee X-rays to check for arthritis and nothing abnormal showed up.
There is no heat or swelling anywhere in the leg.

He comes up positive when doing flexion tests on the fetlock, and is visibly more lame.

He has always been extremely lazy, however this worsens when I bring his head down into a contact. He struggles to move forward in this position. He has always been stiff in his neck and struggles with carrot stretches and sticks his head out when he moves. I’m thinking maybe an MRI on the neck and leg is the best option right now?

Some more notes about him:
  • he struggles a lot to do canter transitions
  • he has bucked me off a couple times, once when hacking and once after a jump landing and seems quite uncomfortable in canter (can try and bronk a bit)
 
Ellie26200 said:
Some more notes about him:
  • he struggles a lot to do canter transitions
  • he has bucked me off a couple times, once when hacking and once after a jump landing and seems quite uncomfortable in canter (can try and bronk a bit)
Click to expand...
A lame horse will obviously struggle with all of the above.

Perhaps the next place to investigate is the hocks and suspenseries.
 
Amymay Again said:
A lame horse will obviously struggle with all of the above.

Perhaps the next place to investigate is the hocks and suspenseries.
Click to expand...
As I said, his suspensory ligament in the lame leg was checked by nerve blocks and lameness didnt improve.
As for the hocks, if there was a problem there, wouldn’t the hind legs be lame, not forelegs? Also wouldn’t it show on hind leg flexion tests?
 
Zoeypxo said:
Did they block out the whole foot?
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He blocked the pastern at the back and the back of the fetlock. He didn’t go inside the fetlock joint as he said it’s risky as can promote septic arthritis. He said blocking the back of the fetlock should have improved the lameness slightly if it was to do with the joint but it didn’t. He also xrayed the fetlock and navicular and didn’t see any problems.
It does concern me that the fetlock flexion tests were positive.
 
Ellie26200 said:
He blocked the pastern at the back and the back of the fetlock. He didn’t go inside the fetlock joint as he said it’s risky as can promote septic arthritis. He said blocking the back of the fetlock should have improved the lameness slightly if it was to do with the joint but it didn’t. He also xrayed the fetlock and navicular and didn’t see any problems.
It does concern me that the fetlock flexion tests were positive.
Click to expand...

Do you have insurance?
A bone scan would be a sensible way forwards if you have insurance or if it is affordable, i think its between 1500-2000£.

If not it seems like a neck x ray could be telling.
 
This has probably already been considered but because of my recent experience I thought I’d ask…have they scoped for ulcers?!

I’ve literally just done the same with my ex racer…took him for lameness investigations as he felt lame behind. Anyway long story short they couldn’t find any lameness, just globally weak and lacking topline etc. the vet hand a hunch he might have ulcers (he was a bit ribby) he was also not going forwards in canter and was quite lazy…anyway they scoped and yes he has grade 2/3 ulcers! He’s on treatment at the moment.

The vet said the reluctance to go forwards and stiffness I felt was probably due to the ulcers. I’ve also recently found this which literally describes how he was trotting at times… he’s a lot better now thankfully and has an almost normal trot…. https://www.facebook.com/share/19W7ofLhTf/?mibextid=WC7FNe

Anyway just wanted to share in case your boy also has ulcers as he’s incredibly common in ex racers, 80-90% depending what you read. Yours does sound more complicated but the bucking etc made me think ulcers could be an issue x
 
little_critter said:
Could you get a referral to a vet hospital for a full work up with a specialist (I’m assuming the work so far has been with your ‘general’ equine vet)
Click to expand...

This - I’d be wanting to block all the way up, especially given the worsening on flexion (which shouldn’t happen really with neck/back/ulcers). Unfortunately ex-racers can be prone to the weird and wonderful!

My previous one (for example) had an injury to the back of her radius which we located by nerve blocking extensively then imaging - it may have shown up on a bone scan, but just taking screening x-rays of everywhere without knowing where the pain was originating from wouldn’t have helped us. So nerve blocking all the way unfortunately, as long as the horse’s temperament allows. (Poor girl had a PD, AS, Low-4, high-4, carpal joints, ulnar blocked with all no difference, then was completely sound after a median block)
 
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Bobthecob15 said:
This has probably already been considered but because of my recent experience I thought I’d ask…have they scoped for ulcers?!

I’ve literally just done the same with my ex racer…took him for lameness investigations as he felt lame behind. Anyway long story short they couldn’t find any lameness, just globally weak and lacking topline etc. the vet hand a hunch he might have ulcers (he was a bit ribby) he was also not going forwards in canter and was quite lazy…anyway they scoped and yes he has grade 2/3 ulcers! He’s on treatment at the moment.

The vet said the reluctance to go forwards and stiffness I felt was probably due to the ulcers. I’ve also recently found this which literally describes how he was trotting at times… he’s a lot better now thankfully and has an almost normal trot…. https://www.facebook.com/share/19W7ofLhTf/?mibextid=WC7FNe

Anyway just wanted to share in case your boy also has ulcers as he’s incredibly common in ex racers, 80-90% depending what you read. Yours does sound more complicated but the bucking etc made me think ulcers could be an issue x
Click to expand...
Ulcers was the first thing I looked at when the bucking started. Got him scoped and he did have a few, so I got them treated. This was a while ago and he’s still on long-term medication for them to lower the risk of him getting them again.
This is a different issue however, as he is definitely lame in his foreleg/s. Thank you any way for your support, wish you the best with your ex racer.
 
BronsonNutter said:
This - I’d be wanting to block all the way up, especially given the worsening on flexion (which shouldn’t happen really with neck/back/ulcers). Unfortunately ex-racers can be prone to the weird and wonderful!

My previous one (for example) had an injury to the back of her radius which we located by nerve blocking extensively then imaging - it may have shown up on a bone scan, but just taking screening x-rays of everywhere without knowing where the pain was originating from wouldn’t have helped us. So nerve blocking all the way unfortunately, as long as the horse’s temperament allows. (Poor girl had a PD, AS, Low-4, high-4, carpal joints, ulnar blocked with all no difference, then was completely sound after a median block)
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My vet said that blocking above the knee is quite inaccurate as there is too large of an area to cover, and won’t necessarily show the change in lameness. He said that the only way to see this would be for a leg MRI or possibly bone scan.
Also I think (from what I’ve heard) it is possible that the neck/back etc could be the issue due to overcompensation affecting the forelegs?
I agree, it is a bit of a mindfield when you have no idea where the pain is coming from😅
 
Ellie26200 said:
My vet said that blocking above the knee is quite inaccurate as there is too large of an area to cover, and won’t necessarily show the change in lameness. He said that the only way to see this would be for a leg MRI or possibly bone scan.
Also I think (from what I’ve heard) it is possible that the neck/back etc could be the issue due to overcompensation affecting the forelegs?
I agree, it is a bit of a mindfield when you have no idea where the pain is coming from😅
Click to expand...

It’s not as easy as below the knee but is possible. Just doesn’t get done as often and is sometimes a little hit and miss as to if you actually have put the needle in the right place - but I wouldn’t rule it out as inaccurate!

MRIing above the knee is difficult as most machines won’t reach that far up (we measured up for my horse but she was too tall!), and even if your horse is little it would have to stop before the elbow (as it’s a hoop). A bone scan may be sensible, then things can be referred on to a lameness specialist also if needed. Just bear in mind that it won’t pick up anything that is purely soft tissue.

Would be much easier if the horses would just tell us!
 
If your vet isn't sure ask for a referral to an equine specialist in lameness at a big referral centre. Get all 4 legs checked then neck back/SI joint etc as they see fit. If it's been going on for a while and is bilateral there may be two or three other issues. I hope you get to the bottom of it. I was assuming you're insured. It will be quicker and cheaper in the long run than repeated vet visits and second guesswhat is going on .
 
As already said get a referral for a lameness work up.

They are very experienced with this kind of thing and will systematically work through until they fine the issue. The neck sounds like an obvious place to start.

Are you insured? If not ask for a quote* tell them and tel them the limit on the spend. They will target obvious potential causes to be cost efficient.

*it will be a bit "how long is a piece of string". They might find the issue immediately or they may have to work through a few options. But if there isn't insurance it is best to make them aware.
 
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Thoroughbred Assessment Centre

Would you like a fresh set of eyes to evaluate your horse, both clinically and from a retraining perspective? BTRC would like to offer both owners of active racehorses considering the retirement op…
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Might be worth contacting these guys, they do assessment days.
 
Mine had a high suspensory ligament injury that only showed with an above the knee block. It was instant difference, most so for the horse, who strode forward tossing his mane like a Wella advert. He'd not been very lame and I felt awful when I saw how different it felt to him.

I always go to a lameness specialist in a hospital as they could diagnose, treat etc on the same day, with someone who has a good eye and follows a hunch.
 
misst said:
If your vet isn't sure ask for a referral to an equine specialist in lameness at a big referral centre. Get all 4 legs checked then neck back/SI joint etc as they see fit. If it's been going on for a while and is bilateral there may be two or three other issues. I hope you get to the bottom of it. I was assuming you're insured. It will be quicker and cheaper in the long run than repeated vet visits and second guesswhat is going on .
Click to expand...
Agreed ref getting a referral early if you can. I wasted a lot of money (and, sadly time) trying this that and the other with a difficult to diagnose back problem. If I’d bitten the bullet and got a bone scan early on we’d have known straight off that it was a lost cause.
 
little_critter said:
Agreed ref getting a referral early if you can. I wasted a lot of money (and, sadly time) trying this that and the other with a difficult to diagnose back problem. If I’d bitten the bullet and got a bone scan early on we’d have known straight off that it was a lost cause.
Click to expand...
I’m getting a full body bone scan next week, fingers crossed🤞🤞
 
Ellie26200 said:
He has always been extremely lazy, however this worsens when I bring his head down into a contact. He struggles to move forward in this position. He has always been stiff in his neck and struggles with carrot stretches and sticks his head out when he moves. I’m thinking maybe an MRI on the neck and leg is the best option right now?
Click to expand...

Great news that you're getting a full scan done. I have been in your position before and my horse was showing a lot of the same symptoms as yours - 'lazy', unwilling to work in a contact, very stilted movement and reluctant to bend. Sometimes the most obvious place is the best one the start with - I went straight for the neck (and got everything else done at the same time). He had moderate changes and remodelling all the way from C3 - C5. They'll often present in the same way for neck arthritis as they would a suspensory/hock/back, so it's often a case of process of elimination, but neck is my bet.
 
Ellie26200 said:
Hi all,

I am writing in desperate need to try and find out what is wrong with my horse. Was wondering if anyone out there has experienced something similar and could offer some advice, as me and the vet are both pretty clueless..

I bought him end of Jan, he’s an 8yo thoroughbred (had raced 7 times in early life)
I had a hunch that he lame a few months back but everyone told me he was fine and I was sure it was just me being paranoid. In the last month I have noticed it more and decided to get the vet out.

It turns out he was lame on the left foreleg and a little on the right foreleg as well (not as worse as the left). This could be seen more apparently on the lunge on a hard surface.

The vet did nerve block tests in the pastern, behind the fetlock, below the knee (half way up lower leg) and in suspensory ligament. Nothing improved the lameness. We then did X-rays of the fetlock and hoof (including navicular). Vet said everything looked perfect. Also did knee X-rays to check for arthritis and nothing abnormal showed up.
There is no heat or swelling anywhere in the leg.

He comes up positive when doing flexion tests on the fetlock, and is visibly more lame.

He has always been extremely lazy, however this worsens when I bring his head down into a contact. He struggles to move forward in this position. He has always been stiff in his neck and struggles with carrot stretches and sticks his head out when he moves. I’m thinking maybe an MRI on the neck and leg is the best option right now?

Some more notes about him:
  • he struggles a lot to do canter transitions
  • he has bucked me off a couple times, once when hacking and once after a jump landing and seems quite uncomfortable in canter (can try and bronk a bit)
Click to expand...
Sorry to hear about your horse.

Fore limb lameness can often be as a result of neck arthritis. An xray would probably be my next step.

An MRI would be a last resort, not only is it very expensive, there is also an element of risk with any G.A, known as a 'down MRI'. It also depends on the MRI scanner used.

Some insurance companies will only pay 50% of the costs relating to an MRI so worth bearing in mind.
 
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Shoulder / neck or DDFT it’s a wide variety but IME they can all affect each other by compensating. My 22 year old was diagnosed with navicular syndrome in 2009 via soft tissue and also has neck issues- we think he went over backwards before I owned him and did his neck and then spent years compensating hence soft tissue injury. I did an unshod rehab on feet as he was in wedges and shoes as vets recommended and it wasn’t working. Changed his diet and environment and now he is 22 is retired but sound but still has issue with neck flexibility. Can be ridden but I’m busy with others now so he lives like a horse should x
 
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