Injecting the Navicular Bursa and MRI Scans

[Pablo349]

Hello,
My horse went lame just over 2 weeks ago, on his near fore. We called the vet out after 3 days box rest as there was no improvement. The vet did flexion tests, watched him lunged on gravel and in an arena, watched him trotted up ect. He was showing much more lameness when on the right rein (the bad leg was on the outside - which was odd) She then nerve blocked his foot and followed the same exercises to find no improvement or change - if anything he was worse. He was put on a 10 day course of Danilon, 1 packet for every feed = 2 a day, and 10 days box rest.
He was still lame, so x-rays were taken, overall his bone structure id fantastic for a 15 year old (the best she had ever seen!) and couldn't find anything wrong. So she injected his joints at the front of the hoof with steroids - no improvement.
So we have been booked in to inject his Navicular Bursa to try and find the problem. What are you experiences with this?
Also, she said we may have to look at getting an MRI Scan which only has a 70% success rate - what are your experiences of MRI Scans, have they ever found your problems?
Thank You for reading and taking the time out to read my rather long essay! All comments would be gratefully received as we really don't know where to go from here as we have never had issues this bad with legs before.

 

[Izzwizz]

My mare was lame 3yrs ago and had an MRI scan of her hoof, she had a tear to her DDFT and this was the only way to get to the bottom of her lameness which had been on/off for about 9months or so. MRI scan was fabulous and showed up the problem straight away. She also had inflammation to her navicular bursa and had an injection to it. It worked for 2 months then she went a bit footy on it again, not wanting to weight bear. Back she went to Horsepital where they did the injection again, this time it was successful and she has been sound on that leg ever since. The first injection could have failed as she was on box rest for a long time before whereas the second time she had been in work and we didnt have a problem. My experience of MRI was a very positive one, my mare also had a re-scan to confirm any healing, it was great to see the progress of this, albeit slow as it is with tendons..

 

[ihatework]

I'm struggling to understand what is going on I'm afraid. You are saying nerve blocks didn't improve the lameness, how many / how high did the vet block too? No improvement would indicate one of 2 things to me - either the vet did duff blocks or your lameness is originating from higher up. What is vet planning on injecting the nav bursar with, steroid? Its not the easiest place to inject and i'm not convinced there is much diagnostic point in it if you have already had a negative block. 2 weeks isn't long in the grand scheme of things, if you are insured and very worried then id suggest a referral to a large equine hospital but you might just want to consider a bit of Dr green first. As for MRI, you are looking at approx 1.2K, they are very good for diagnosing injuries within the hoof

 

[ester]

ditto if nerve blocks aren't helping I can't understand what MRIing or treating the foot is going to do/help. I don't understand why steroid was given (presumably to coffin joint) without nerve blocking this first? which would have indicated site of problem.

Mine has been lame since November steps were
1) nerve block back of foot = some improvement, xrayed feet and shown improvement so ... improve shoeing and reasses.
2) some improvement but not sound so nerve block coffin joint = further improvement
3)inject coffin joint with steroid and continue with balance improvements.

But I don't know if any of that is relevant if nerve blocks have not indicated a foot problem, blocking the back of the foot would have improved it if it was a navicular bursa problem.

 

[Flame_]

I'm not sure what you mean by MRI success rate. I've had three horses have front feet MRI scans and I believe they have clearly revealed the problems within those front feet but not problems elsewhere on the horse. It is the treatments of the injuries they find which tend to have success rates, and not often particularly good ones IME - no where near 70% full recovery for soft tissue injuries in the front feet.

I'd want to be a bit clearer that the problem is definitely in the front feet before MRI-ing and also that the vets are confident that the horse doesn't have numerous other problems that combined with front feet injuries are not likely to be fixable. IMO it is only worth doing if the vets think it will show something they can put right.

 

[Bikerchickone]

I've been through the mill a bit like this recently too. I chose to have the MRI done rather than trying to treat my horse without knowing what was happaning. The MRI gave very detailed information and my horse was diagnosed with collateral ligament damage, mild navicular and pedal osteitis. However he wasn't hugely lame, 1/10th or thereabouts so we didn't go down the route of trying blocks.

Unfortunately Flame is right about the prognosis regarding soft tissue injuries in the hoof. It isn't good. I found a retrospective vet study which confirmed that 87% of conventionally treated collateral ligament injured horses didn't return to work. My boy has therefore gone to Rockley for barefoot rehab. It's early days but I'm quite hopeful.

IMO you need to know what's going on so that you can look at possible treatment options, so an MRI would be the way to go, but, two weeks is no time at all so I'd be prepared to try a bit more rest before taking that step.

Good luck and I hope it comes right for you.

 

[ester]

bc1 did your boy nerve block sounder first though?

ps have loved seeing him on the blog .

 

[Delta99]

My boy had the navicular bursa nerve blocked when he went lame, showed some improvement. X rays showed changes to the navicular bone, so he then had steroid injections into the navicular bursa.
Seemed to work initially... and then caused laminitis so would not go down that route again.
Had MRI done, showed severe damage to impar ligament (small ligament by the navicular bone).

I debated a long time about the MRI because of the cost but am glad I had it done as it's given me a much better picture than the x rays.

Doesn't improve the treatment options though.

I don't really understand why your vet wants to inject the bursa if there is nothing showing on the x rays tbh...

 

[summerguest]

My mare had MRI scans when she went lame 5 years ago. The scans are excellent and showed she had inflammation of the navicular bursae, all the xrays were negative showing no bone damage. However knowing the problem doesn't guarantee a solution! I decided to take her shoes off and throw her out in the field for a year. She has been mainly sound on light work since, had one relapse where she had to have bute for 6 months. If she is insured go for it, if she isn't then I wouldn't bother.

 

[Bikerchickone]

bc1 did your boy nerve block sounder first though?

ps have loved seeing him on the blog .

Thanks Ester! No we didn't nerve block at all because we were sure the problem was in the feet. Vet had anticipated navicular but I didn't want to continue with wedges without knowing for sure what was happening. Luckily though I do have insurance and they're being really good about it all.