Injecting the Navicular Bursa - your experiences

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Pablo349

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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.
 
I guess your vet is thinking navicular to suggest blocking the navicular bursa and to raise the possibility of MRI scans.

One of my horses had a nerve block in the navicular bursa this week, but as she was still showing slight lameness, the problem was located further up in the coffin joint, which she had medicated and all is well.

Unless you're with an insurer that will pay for MRI it's a very expensive option, well over £1000. Petplan will pay for it on a vet's recommendation and if the legs aren't already excluded. NFU I think will pay half. Personally I wouldn't pay for it out of my own pocket unless the horse was very valuable. I would get X-rays. Even some soft tissue problems can be seen on X-rays, and certainly anything like ringbone, foot balance and a load of things that could be affecting the lameness. Two weeks is a short time to be thinking about such an expensive and drastic course as MRI.

Since you're in Hampshire, I can recommend Trevor Jones who is a DAEP, and seems to have MRI vision into the foot! I know he is very booked up, but I'm sure he would take a look and if he couldn't take you on himself, he has other DAEPs that he is prepared to stake his reputation on. This would probably be a good route to go down if the lameness persists.

http://www.equinepodiatry.co.uk/
 
I can see no logic in injecting the navicular bursa if a palmar digital nerve block did not improve the lameness. Your horse needs further nerve blocks going higher up the leg to find the region causing lameness.
 
Pablo, your experiencing something very similar to what I am going through with my chappie now, we havent had the Navicular Bursa injected as we have opted for the MRI (happening next Friday......)

I can only tell you what the vets believe is wrong with my chappie, Xrays were clear - again everything looked good, U/S of the top portion of the DDFT and the Collateral Ligaments again were clear but lameness was gone when the hoof was blocked so definitely in the hoof.

Vet wanted to block the Coffin Joint and the Navicular Bursa but bizarrly the horse was too sound to do this the following day.

Now not to worry you but My vet is thinking we have soft tissue damage on either the collateral ligaments or the Deep Digital Flexor Tendon, Collateral Ligament damage apparently presents lamer when the affected foot is on the outside of a circle.

Now im no expert but that could be what your vet is trying to dignose or rule out by blocking the NB.
 
Yes we did about 5 years ago and NEVER again, my horse was slightly lame before and very very lame after, leg got infected and we were lucky not to have to have an operation. We then changed vet who suggested an MRI scan which is the best thing we ever did.... it points out exactly what is wrong with your horse, in my case 7 things in one foot and 11 things in the other...then you at least have a basis on what treatment/ management you can give.
 
MRI's are a very good diagnostic tool to work out what is going on in the foot as you can't scan the soft tissues there as you would higher up the leg.

But that's all they are, a method of diagnosing what is wrong. Treatment comes after depending on what they find and the outcome depends on what they find.

However I don't really see why your vet wants to start injecting and MRI'ing the foot when your horse hasn't nerve blocked to that area.

In most cases if they do not nerve block sound to the foot, they nerve block higher up the leg until they work out where the issue is.

Lamer on the outside of a circle can indicate issues in the foot (inside I think) but it can also indicate a high suspensory injury on the outside of the leg.
 
Pablo349 said:
Hello,
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.
Click to expand...
My best advice is to push for a clear and confident diagnosis, and then before agreeing to any procedures, understand what they will cure. I am concerned that the route they're taking is rather unsure and could end up very expensive both in terms of the horse's health and your pocket (insurer's pocket). If they think the problem is in the Navicular area, then what do they think any further injections will do for that joint? So far I have not seen any cure from this course of treatment, just temporary pain relief.
 
Our WB had his coffin joints injected in december as the problem was located there via xray and nerve block.Also his offside fore has long been unbalanced due to an old injury which caused him to dish severley.This over time put pressure on the offside foot which is where the main problem is.The injections were effective,and with remedial shoeing his left limb is much straighter and the dish considerably less pronounced.He is extending well in trot and working well.Injection to the left side is waning as Vet opines that as his foot is realigning it is probably sore at the moment.He is not lame but just a little short on the nearside.Injections to both joints are being repeated on wednesday.
 
I do hope the OP replies, as she also posted this in NL but didn't answer any of the queries about what was being done and why the vets thought it was a foot issue.
 
Hello All,
My horse went through injecting the Navicular Bursa on Monday - he was just as lame after the injections as before. So he is now on 3 months field rest - a very small paddock. On 19th June the vet will come out again and re-asses his condition - if not better, or only a slight improvement we will look into MRI.

My horse is type that gets bored very easily and box rest was NOT and option.

I can understand some of your queries:
1st. Because the vet is also concerned with my horses action with his hind legs (very stiff) she believes he is putting all pressure onto his bad hoof and therefore creating a problem.
2. He has a very weird action you pick up the bad leg in that you pick it up and he couples up underneath bringing both back legs underneath him whilst you still have hold of the leg - he obviously feels comfortable in this position but does not do this action with any-other leg.
3. After injecting the Navicular Bursa we believe if is probably soft tissue or ligament/tendon tears or twinges - in which case REST is best cure. We have been told that is this is the case we could use shock-wave therapy to help.

Our amazing physiotherapist is coming out next week to check up on him and do some treatment.

Thank You all for your input and I will update as and when we have news. For now he is happy being outside!
 
alsiola said:
I can see no logic in injecting the navicular bursa if a palmar digital nerve block did not improve the lameness. Your horse needs further nerve blocks going higher up the leg to find the region causing lameness.
Click to expand...

This was my first thought, too. Why is the vet persisting in injecting the foot when a nerve block of the foot showed no improvement? Surely you need to use the nerve blocks to locate the source of the lameness?
 
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1 and 2 would make me suspect that there was something going on higher up, if the vet is suggesting that there is a problem behind making him lame in front why are they not investigating the hinds aswell?

I don't think I would be happy with the current diagnosis as it stands although field rest might be a sensible way to go regardless of diagnosis.

on point 3) the vet is suggesting it is soft tissue damage in the foot? why have they not been able to block it then? did they provide any explanation for this?

I admit to being rather baffled at this horses' work up? is this a equine specialist vet?
 
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