How lame was your horse before nerve blocked?

[Illusion100]

Follow on from this thread.

http://www.horseandhound.co.uk/foru...u-manage-Navicular&highlight=manage+navicular

Work-up has been done(ish).

Horse trotted up on concrete, then lunged on soft and hard surface. RF was showing up as a bit of an issue. Then both forelimbs flexed. LF, not a lame step. RF, lame from the get go. I'd say a consistent 2-3/10ths after flexion. Nerve blocks bypassed. No hoof testing/wedge test/frog test performed.

X-rays of both front feet done. Nothing in the feet, no bony change jumping out, no rotation and good balance in general. Good sole thickness, scope to shorten toes up.

Now, this is where I'm a bit perplexed.....

Vet did not feel that blocking would be of any benefit at this stage as they felt the degree of lameness would not be altered enough to warrant it.

I agree, the horse wasn't hopping lame after flexion but it was obvious, you couldn't miss it, nothing iffy about it. My little brain can't figure out why blocking wasn't done? Ime, a low level but evident lameness usually always disappears after blocking and if not you tend to have a much more complicated/serious issue. I'm also a touch confused why x-rays were performed on the forefeet without having blocked as the problem could be anywhere in the limb? X-rays aren't cheap and neither do they necessarily equate to lameness presented unless at least supported by blocking results?

X-rays did however show bony change in the RF fetlock, again this may or may not be the cause/main factor of the lameness but why was blocking still not performed at this stage to assess this clinical finding in relation to the positive flexion?

When asked if Navicular could be a potential cause, it wasn't ruled out but expressed that it is usually bilateral. Wouldn't be the 1st time Navicular has presented unilaterally, particularly in the early stages.

Advice was to bute and ride for the next few weeks, then take off bute and see what happens. Bar shoes were suggested also but I can't justify why based on todays findings?

So we've wandered off nonethewiser about the cause of the lameness but costs are now up to nearly £400. What am I missing???

 

[Annagain]

My share horse was never lame enough to block when he had his (suspected) hock problem, hence no x-rays and no definitive diagnosis. Good in a way as he recovered well so hoping it was nothing serious, but the uncertainly over whether it was an injury or the start of arthritis is still hanging over us. He gets to start jumping again this weekend (after 2 months of box rest, 2 months of hacking and another 2 of flatwork as well) and I'm nervous it might come back when he does.

 

[Goldenstar]

Usually if a nerve is not done it's because the answer is so blindingly obvious it's not worth the cost.
It would also show if the horse is bilaterally lame but worse on one side .
Of course if they don't know where to start blocking it would be an expensive job .
Which flexion made the horse lame ?

 

[Illusion100]

My share horse was never lame enough to block when he had his (suspected) hock problem, hence no x-rays and no definitive diagnosis. Good in a way as he recovered well so hoping it was nothing serious, but the uncertainly over whether it was an injury or the start of arthritis is still hanging over us. He gets to start jumping again this weekend (after 2 months of box rest, 2 months of hacking and another 2 of flatwork as well) and I'm nervous it might come back when he does.

Fingers crossed for you, please pop at least an update on this thread how he fares after this weekend.

 

[Illusion100]

Usually if a nerve is not done it's because the answer is so blindingly obvious it's not worth the cost.
It would also show if the horse is bilaterally lame but worse on one side .
Of course if they don't know where to start blocking it would be an expensive job .
Which flexion made the horse lame ?

Generic forelimb flexion. No obvious cause noted for the lameness. Head bobbing noticeable when lunged on right rein, more so on hard surface.

Vets I worked for always started blocking from the foot on a positive flexion limb (unless as you say the cause was very obvious to have no need) to help identify where to x-ray and help identify any subtle bilateral (or more!) lameness.

 

[Annagain]

Will do. I imagine this weekend will be fine. I'm having a flatwork lesson with 5 minutes of jumping at the end to ease us back in. I think it'll be if/when we start doing more sustained leaving the ground it will manifest itself if there is an arthritis problem. He's 19 so wouldn't be massively unexpected or feel too unfair given some get it at 5 or 6 but jumping him is such a pleasure I don't want it to have to stop.

 

[ester]

3/4 10ths on the hard on a straight line or a circle in front.

More recently not right behind 1-2/10 and given 3/10 after flexion but insufficient to block and given age of horse a degree of deterioration and that we weren't going to go the injecting joints route not investigated further.

Im not sure joint blocking for lameness only seen after flexion is particularly helpful tbh/your flexions then have to be identical?

 

[budatiger]

1/10 hind limb, but higher up hock region. Upon blocking, the other hind was noted & then sequentially all four limbs.

 

[ester]

I'm otherwise advised that 3/10 post flexion would be fine to work with .

 

[ester]

Navicular hasn't really been ruled out because they don't know if there is anything bilateral going on if they didn't block the 'lame' leg.

they could have navicular in both - and bony changes in one fetlock

 

[Goldenstar]

We have blocked for one tenth lame after flexion but we where pretty sure what we where looking at .
I would get the whole foot blocked out and see what happens .

 

[ycbm]

I would demand nerve blocks, bad foot first.

 

[be positive]

I had one blocked that was barely unlevel, I would say less than 1/10, it was only on a circle on hard, it was no different after flexions but there was just enough to see an improvement when blocked to the foot, as it was so subtle he went back the next day for more specific blocks, he xrayed clear and it was thought to be minor soft tissue damage/ bruising so he was rested/ light work for a month which was enough to resolve the problem, the next step would have been MRI.

 

[Kezzabell2]

My horse must have only been 1/10 lame but he was rearing when and unhappy to be ridden, so he went in straight away for a full lameness work up and was nerve blocked then! so must have been 2 days after the vet found he was lame! I didn't even know he was lame

 

[Goldenstar]

I had one blocked that was barely unlevel, I would say less than 1/10, it was only on a circle on hard, it was no different after flexions but there was just enough to see an improvement when blocked to the foot, as it was so subtle he went back the next day for more specific blocks, he xrayed clear and it was thought to be minor soft tissue damage/ bruising so he was rested/ light work for a month which was enough to resolve the problem, the next step would have been MRI.

Exactly like mine he came sound on box rest and shoes removed .

 

[Fun Times]

Hi Illusion100. Not your boy I hope?? They blocked my horse when he was about 2/10 lame. He was only lame on a hard surface circle, fine in straight lines. However, they got the wrong diagnosis and thought he had blocked to a small splint initially (when in fact the problem turned out to be lower down). So we spent six weeks focusing on the splint only to realise it was a red herring. In your position, I too would be wanting more definitive answers but I guess the point of my post was just to say that nerve blocks arent infallible either.

 

[Micropony]

My old horse was nerve blocked 2/10 lame. It was obvious which leg, but not where. Vet thought probably foot, farrier thought higher up. Nerve blocks all the way up (took so long vet ran out of time on first visit, so had to come back another day to finish the job) showed nothing, I.e. remained stubbornly 2/10 lame. Ended up going to horsepital for a bone scan, which identified the hotspot, which enabled them to know which bits to look at further. Turned out to be collateral elbow ligament.

So frustrating when you don't know what you're dealing with, and vet doesn't come up with a clear logical plan for doing so that they explain to you!

Really hope you manage to get to the bottom of it and the vet can give you a nice clear plan for fixing your horse!

 

[Illusion100]

Not my horse but a friends.

I just thought nerve blocks would have been useful, to at least the RF hoof.

 

[Slightlyconfused]

Generic forelimb flexion. No obvious cause noted for the lameness. Head bobbing noticeable when lunged on right rein, more so on hard surface.

Vets I worked for always started blocking from the foot on a positive flexion limb (unless as you say the cause was very obvious to have no need) to help identify where to x-ray and help identify any subtle bilateral (or more!) lameness.

my vets have nerve blocked after a lame flexion just to make sure we are in the right place so we aren't wasting money xraying the wrong area. not that expensive and easy to do....well on mine I is anyway he just stands there.

 

[crabbymare]

assuming there is no obvious sign of where the lameness is from I would have thought a nerveblock would have been done before xrays so that you would have known where to xray? unless the flexion test was pointing conclusively to a specific joint but its hard to say without seeing the flexions done

 

[stencilface]

2/10 lame in straight line, better on soft circle. Worse on hard circle, no flexi on test done, but leg pal payed. Blocked caudal hoof on near fore. Which then on trot up showed 1-2/10ths lame on the off fore. X-rays showed nothing ( done to confirm no metal in hoof) mri showed ddft damage in both front feet.

Always worth blocking IMHO if no lame ness found. If there's nothing obvious, then from experience it's always more complex and expensive. I'll be honest, that's why I go straight to rainbow vets, they have everything on site and pretty much exhaust everything they can to figure out the lameness. It's just to hand so it's easy for them to nerve block, X-ray, Mri, no bother. Get your friend to rainbow

 

[wills_91]

I will dig out a video of my mare later who is so subtly lame it is almost impossible to see, she got nerve blocked on ref feral to the vet school and after 6 weeks box rest showing no improvement she got an mri scan - she has a bone cyst and it is more than likely ended her ridden career. I will be more pushy next time even with a subtly lame horse.

 

[glamourpuss]

2/10' th's lame on a circle on the concrete. No reaction to hoof, heel or frog testers. No flexion tests done, nerve blocked foot (no change), nerve blocked suspensory region (instantly sound) - u/s scan showed PSD.
I requested foot x-Rays to help farrier with the remedial shoeing.

i've only ever had X-Rays done without nerve blocks as a 'loss of performance' work up where there was no actual lameness to work with.

 

[Annagain]

Fingers crossed for you, please pop at least an update on this thread how he fares after this weekend.

Have put a little update thread up - all good Hope your friend is closer to some answers or at least has a plan of action.

 

[Illusion100]

Have put a little update thread up - all good Hope your friend is closer to some answers or at least has a plan of action.

Can't see your thread? Where is it!

No answers at this point but there is a plan of action(ish).

 

[Annagain]

It had dropped off the first page

http://www.horseandhound.co.uk/forums/showthread.php?711459-Pointless-happy-post

 

[Pinkvboots]

I would have wanted nerve blocks done as flexion tests are not that accurate, my horse was 4/10 lame after each flexion on the same leg so they were none the wiser where the issue was, so he was nerve blocked from the foot up and only went sound on the suspensory block so was scanned there.

I can't understand why they did X rays on the feet as they had no idea where the problem was, seems a bit of a waste of money to do so without nerve blocks first.

 

[Illusion100]

I will dig out a video of my mare later who is so subtly lame it is almost impossible to see, she got nerve blocked on ref feral to the vet school and after 6 weeks box rest showing no improvement she got an mri scan - she has a bone cyst and it is more than likely ended her ridden career. I will be more pushy next time even with a subtly lame horse.

You got that vid? I'm sorry to hear about your mare, is there any chance she will come right?

 

[Illusion100]

I can't understand why they did X rays on the feet as they had no idea where the problem was, seems a bit of a waste of money to do so without nerve blocks first.

Me neither but not my horse so couldn't really say much about it at the time.

What will annoy me though is if after the immediate plan of action, the Vets choose to nerve block and then re x-ray the front feet!

 

[Illusion100]

Get your friend to rainbow

It may well end up that way!