Flexion tests for older horses?

[tobiano1984]

Had a sleepless night getting annoyed about this so thought I’d see what others thoughts are.
One of my horses, a 17yo lightweight cob gelding, is on loan to some wonderful friends who treat him like a king. Recently, in the last month, he showed some signs they were concerned with - pulling his head down after jumps (we’re talking 70cm here), and then more recently was reluctant over trot poles so being conscientious sorts they stopped exercise and got the vet out.
I spoke to the vet on the phone during the visit and whilst I’m not questioning their expertise at all I did have to remind them what was in front of them - when they started suggesting full body bone scans. They’d also done a FLEXION TEST on my 17yo boy and declared him lame in 3 legs.
I’m a qualified veterinary physio and during my degree a lot of our professors (vets, scientists etc) were quite anti Flexion tests full stop, in any age horse. But to my mind doing them in a teenaged horse is just ridiculous. I certainly wouldn’t pass a Flexion test myself.
Anyway, after making my feelings known, the body scan, full body nerve blocks etc watered down to a 10 day bute course and steady building up.

I digress - the crux of my post is do Flexion tests have any validity on older horses? To my mind with age, likely OA of some degree, and general age related stiffness it just isn’t a fair evaluation.

 

[TheMule]

Of course they do- flexion tests are used to pinpoint which joint is painful. You then do further diagnostics on that joint, or you are more conservative and you go straight for joint injections, or you don’t bother trying to help individual joints and you just go for anti-inflammatories which is what it sounds like you have chosen.

 

[ihatework]

It’s not an unusual thing for a vet to do though, so I wouldn’t get too upset about it.

I suppose you need to have a think about how far you want to investigate on a lame 17yo. If you and loaners want to keep the loan going with a view to keeping him in a reasonable amount of work, then some form of imaging is necessary so you know where to target treatment.

Personally, I’d use a good orthopedic old school vet who would get a gut feeling from flexions and watching the horse move, where the issues might be and then strategically X-ray.

 

[gallopingby]

Flexion tends depend on the skill of the person doing them and the fitness of the horse.

 

[Highmileagecob]

You probably know in your own mind, that at 17yo and showing reluctance, he is asking to wind down a bit. Hopefully, it is nothing serious, and you will be able to keep him comfortable. I wouldn't rule out flexion, it can be a good indicator of developing issues, but as you say, leaping straight in with the full range of body scans etc, sounds like a bit of overkill. What do his feet look like? Have you seen the horse recently? What are your thoughts?

 

[tobiano1984]

Of course they do- flexion tests are used to pinpoint which joint is painful. You then do further diagnostics on that joint, or you are more conservative and you go straight for joint injections, or you don’t bother trying to help individual joints and you just go for anti-inflammatories which is what it sounds like you have chosen.

I'm aware of the purpose, but the vet basically did them, told my loaner he was lame in 3 legs and she couldn't tell what joint it was. Which suggests a lack of experience, unfortunately it's in an area I don't really know the vets, my old one used to be able to diagnose them from just watching them move. I think you'd be hard pushed to find a horse over 15 that trotted away flawlessly from a flexion test, but maybe I'm being cynical.

 

[tobiano1984]

You probably know in your own mind, that at 17yo and showing reluctance, he is asking to wind down a bit. Hopefully, it is nothing serious, and you will be able to keep him comfortable. I wouldn't rule out flexion, it can be a good indicator of developing issues, but as you say, leaping straight in with the full range of body scans etc, sounds like a bit of overkill. What do his feet look like? Have you seen the horse recently? What are your thoughts?

Yes, he owes nothing to anyone so if he needs to retire he will. It just seemed like the vet did flexion tests but got no read on the results, so suggested overkill scans. His feet are fantastic - barefoot most of his life, I haven't seen him in the flesh for a couple of months but have seen videos. he looks like he's dropped a bit of muscle but certainly not lame to my eye.

 

[tobiano1984]

Flexion tends depend on the skill of the person doing them and the fitness of the horse.

Yes quite, just seemed a bit much for a 17 year old happy hacker and a clearly very young vet

 

[tobiano1984]

It’s not an unusual thing for a vet to do though, so I wouldn’t get too upset about it.

I suppose you need to have a think about how far you want to investigate on a lame 17yo. If you and loaners want to keep the loan going with a view to keeping him in a reasonable amount of work, then some form of imaging is necessary so you know where to target treatment.

Personally, I’d use a good orthopedic old school vet who would get a gut feeling from flexions and watching the horse move, where the issues might be and then strategically X-ray.

He owes nothing, so if he's not comfortable he'll just retire. I have no interest in stuffing him with steroids and whatnot just to get a couple more years out of him. I wish I knew the vets in the area but sadly not!

 

[TheMule]

I'm aware of the purpose, but the vet basically did them, told my loaner he was lame in 3 legs and she couldn't tell what joint it was. Which suggests a lack of experience, unfortunately it's in an area I don't really know the vets, my old one used to be able to diagnose them from just watching them move. I think you'd be hard pushed to find a horse over 15 that trotted away flawlessly from a flexion test, but maybe I'm being cynical.

Then it suggests there are multiple joints involved so the vet has recommended the gold standard next course of action. You don’t have to take that course, but that would give the horse the best chance of successful diagnosis. If the vet had just said, 'Bute him up and see' I'm sure there’d be complaints about that too. You stated in your OP that’s you’re ’Not questioning the vet's expertise at all' but then clearly do.

 

[tobiano1984]

Then it suggests there are multiple joints involved so the vet has recommended the gold standard next course of action. You don’t have to take that course, but that would give the horse the best chance of successful diagnosis. If the vet had just said, 'Bute him up and see' I'm sure there’d be complaints about that too. You stated in your OP that’s you’re ’Not questioning the vet's expertise at all' but then clearly do.

Yes I guess I am, but I think you have to, they're not infallible and i think in this case possibly just very young/new and keen to throw everything at it. Until they found out he's insured for accident only! He doesn't tolerate vets at the best of times so certainly won't be putting him through investigations, I'd just retire him if he doesn't come around with conservative management.

 

[MuddyMonster]

I had flexion test's done as part of the lameness work up I had done on my veteran. I think they are quite standard and can be useful.

I think vet's can be in a difficult situation- they advise gold star treatment, they can be accused of money grabbing or out of touch with what the owner wants. If they suggest a more conservative treatment, why didn't they suggest more if it could have helped?

During the lameness work up I had (which was over multiple visits), the vets explained all options for me and we agreed on the most suitable course of action from those - based on what was best for my horse, my preferences/concerns, what the financial implications were and our long term goals. I didn't go down the gold star treatment but I'm glad it was offered to me as an option.

I've taken the gold star treatment on other occasions, when it's been the right thing to do in that scenario for us.

Hope you get your horse comfortable again.

 

[smiggy]

As someone with an older horse that also is not going to be doing bone scans etc, would highly recommend steroid hock injections. Non invasive, not expensive and can really help an older horse stay happy in work. Worth a try before retiring anyway .

 

[tobiano1984]

As someone with an older horse that also is not going to be doing bone scans etc, would highly recommend steroid hock injections. Non invasive, not expensive and can really help an older horse stay happy in work. Worth a try before retiring anyway .

this was what we were expecting to do, I think I might get a more experienced vet out who will be happy trying it out without all the bone scans etc

 

[lme]

Gosh - I wouldn't allow a vet to flexion test one of mine, especially not an older horse. Fortunately we have a good lameness vet. They have always managed to pinpoint the cause of any issues without resorting to body scans or 'block the feet and work upwards' investigations.

 

[tobiano1984]

Gosh - I wouldn't allow a vet to flexion test one of mine, especially not an older horse. Fortunately we have a good lameness vet. They have always managed to pinpoint the cause of any issues without resorting to body scans or 'block the feet and work upwards' investigations.

Yes, I would not have allowed it if I'd been there, I think a more experienced vet is needed!

 

[Fieldlife]

I’m quite happy to allow flexion tests on an older horse and think forms a part of picture but not whole picture. Are some what subjective. But it’s interesting is 3 legs of 4 and not all 4.

 

[Highmileagecob]

Don't be too harsh. She may be following practice policy, which is difficult for vets who would like to use their own expertise and common sense.

 

[Midlifecrisis]

I had the oldie I bought (16 years old) stage 5 vetted and she passed the flexion tests so maybe they are showing something in your horse even if it’s a bit of a brutal way to show it up.

 

[poiuytrewq]

this was what we were expecting to do, I think I might get a more experienced vet out who will be happy trying it out without all the bone scans etc

You wont need bone scans to inject hocks. A quick x-ray maybe nut definitely not a bone scan. I'd like to think If i asked on a 17 yo who'd trotted up lame after a flexion that my vet would probably agree to just inject and see what happened.

 

[Zoeypxo]

FWIW, i know plenty of people with older horses who have been a bit off/stiff behind who then inject hocks without much investigation due to cost or the fact of the horse being older and hocks being a likely suspect..
Half of the time it makes absolutely no difference because it was actually the stifle, or the neck , or suspensories.
So whilst a bone scan is a bit far out i do think a basic set of x rays and nerve blocks are invaluable.

 

[Bron]

My boy was 16 years old when I bought him last year but he still had to pass the flexion tests to pass the Stage 5 vetting. Very proud that he passed with flying colours!

 

[Equi]

I had my 16yo cob/clyde 2* and he passed flexion and everything else with flying colours. My old boy at 16 would not have even nearly passed them, but was still a useful horse until 21.

 

[Bonnie Allie]

OP - I am so with you on this one. Due to the manual nature of the test as well as the variability of the skill in the vet in conducting such, a flexion test gets variable results. I also agree at 17yrs something is going to show up - all that it tells you however is there is something somewhere in that limb…………maybe…….

Flexion tests for me are right up there with BMI stats for women. Effing useless.

P x Q doesn’t always equal R.

 

[Red-1]

I would expect a flexion test. The whole thing of body scans is, IMO, as a result of insurance paying their bills. I have found the same with my dogs. Neither of them is insured but, until they knew that, the vet told me that one needed a GA and £900 worth of dental treatment. The dog looked and behaved fine, and I refused. The funny thing is, I was taking ownership of the dog and went back a short time later for the final jab, and asked a different vet (same practice) how his teeth were, and she said fine!

Nothing wrong with the suggestion, but it would be an easier life, hock injection, or course of bute for me too. Or all 3.

 

[sportsmansB]

I would expect them to try flexions (but with the expectation that they had the expertise to understand the outcome) and then nerve block to find the joint in question, and then probably x ray and medicate with injections where necessary
There is absolutely no reason why an otherwise happy 17yo horse can't continue on in low level work with medicated joints for a few more years
Bute without finding out what the source of the issue is is a sticking plaster in my opinion if it isn't something which came on very suddenly.

 

[sbloom]

As someone with an older horse that also is not going to be doing bone scans etc, would highly recommend steroid hock injections. Non invasive, not expensive and can really help an older horse stay happy in work. Worth a try before retiring anyway .

Joint injectionns are not without their downsides and side effects, I would not want to inject any joint without proof that's where the problem lies, and even then it's just the start, that in most cases they're then needed for ongoing maintenance, or, better, they're a window to help the horse move better. Even an older horse can develop better posture and reduce compensatory movement patterns with the right work, and forgive me but so often the right work, imo (and many others) is not the "rehab" programmes given out by many vets and even bodyworkers.

 

[tobiano1984]

I would expect them to try flexions (but with the expectation that they had the expertise to understand the outcome) and then nerve block to find the joint in question, and then probably x ray and medicate with injections where necessary
There is absolutely no reason why an otherwise happy 17yo horse can't continue on in low level work with medicated joints for a few more years
Bute without finding out what the source of the issue is is a sticking plaster in my opinion if it isn't something which came on very suddenly.

it has come on fairly suddenly - the horse was winning hunter trials a couple of months ago (albeit 60cm ones!). He has prior form for winter problems - never done well with cold and being stationary.

 

[tobiano1984]

Joint injectionns are not without their downsides and side effects, I would not want to inject any joint without proof that's where the problem lies, and even then it's just the start, that in most cases they're then needed for ongoing maintenance, or, better, they're a window to help the horse move better. Even an older horse can develop better posture and reduce compensatory movement patterns with the right work, and forgive me but so often the right work, imo (and many others) is not the "rehab" programmes given out by many vets and even bodyworkers.

Yes I agree - I think I will need to help the loaner with his posture etc - he was always a tricky one but I think when I was riding him exclusively it was easier to keep him supple and work on his many compensatory issues - his teenage loaner is very conscientious and keen to do the right thing but obviously needs guidance.

 

[tobiano1984]

I would expect a flexion test. The whole thing of body scans is, IMO, as a result of insurance paying their bills. I have found the same with my dogs. Neither of them is insured but, until they knew that, the vet told me that one needed a GA and £900 worth of dental treatment. The dog looked and behaved fine, and I refused. The funny thing is, I was taking ownership of the dog and went back a short time later for the final jab, and asked a different vet (same practice) how his teeth were, and she said fine!

Nothing wrong with the suggestion, but it would be an easier life, hock injection, or course of bute for me too. Or all 3.

YEs I think we try the bute course and see if that helps, as I'm slightly of the mind that as it came on quite swiftly it might be more of a tweak/field injury or something. He has form - when i got him as a rescue abuse case he had a hideously twisted pelvis, and was chucking everyone off - sorted that with a osteo and lots of time. Then if no improvement maybe get a more experienced vet out who can assess joints with x-ray/exam rather than bone scans! I've had the same experience with dogs and horses....this horse lacerated his hock year before last in the field and the vet was trying to admit him to hospital 'as a precaution'.