Lameness in near fore - thoughts?

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acw295

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Hi all, interested to know what people make of these symptoms please, as I am trying to identify things to keep an eye on/mention to vet on while I am waiting for a lameness workup on my pony, booked for 4 July.

Pony is 14.2hh Welsh Dx 18 years old with no history of lameness apart from splint fracture surgery in 2012. She probably has slight arthritic changes in off hind but not diagnosed by vet and not caused any issues to date (chiro & farrier have mentioned she is less flexible on that leg but that it is likely to just be age related wear and tear).

On 1 May whilst doing some simple trot poles she did an odd stride over the poles and pulled up holding up her near fore. She hadn’t knocked the poles as they hadn’t moved. I leapt off and after a few mins she was able to put it down and walk out of the school. I hosed it and within minutes she seemed sound on it and continued to trot up sound over the following week. She was rested as a precaution for a week but on her usual field/stable routine and given 1 bute a day. There was no heat, no obvious swelling. There was some debate amongst those that felt her leg that there might be a tiny bit of swelling in fetlock area but as she has windgalls this was difficult to tell from what is usually there.

I started with light hacking for 2 weeks with the view that it should bring any issues to light and no obvious issues seen. Then the weather was dire and work very busy, and then I was away on hol so she probably did about 5 or 6 short walk hacks with a bit of trot and canter over a month. She is normally worked 4-6 times a week so this was a substantial reduction in work for her.

I rode her on Sat & Tues and she was ok in walk, reluctant to trot on all surfaces and the trot felt short, but no nodding. She usually has your typical big moving Welsh trot but this didn't go anywhere and she was asking to stop. Yesterday I hacked again, fine in walk but reluctant to trot again on tarmac and grass. I pushed the trot on and it still felt short, then immediately afterwards the walk felt unlevel. No head nodding, no obvious lameness though but she didn’t feel “right” at all. On the way home we have a fairly step downhill stretch and she was much more hesitant with this than usual, so I got off and walked her back and she seemed to be moving slightly oddly on the near fore. Still no obvious heat or swelling although I’m still not sure if her windgalls are more pronounced or not – but this could be a red herring.

I am planning to try her in the school over weekend for a few mins just to see how she is on a soft surface and otherwise rest until vet. Lameness assessment is at the yard as we have serious loading issues, am not convinced they will find anything straightaway so am aware she might have to go in which will be an ordeal. My vets is a big hospital with MRI (Oakham) at least if that is needed so she shouldn't need referral.

Other dilemma is that she doesn’t lunge – as in she has no idea, gets very upset and canters about bucking then rearing. It’s never been something that bothered me as no need to lunge her but worried now that this will be an issue for lameness assessment!

Is there anything specific I can try ruling in/out before vet comes to make the most of the visit? Am concerned that with rest she is going to appear sound. The only thing I have to go on is the issue with the near fore over the poles as she clearly hurt something then – and after pushing the trot yesterday she was definitely not using the same leg quite right. So that does point to the source of the problem although I am open minded to other things!
 
could it be something like check ligament desmitis. My horse has been off with this and displayed similar symptoms to yours. Mine is 14yrs old and aparantly it's more common in teens/older horses. With my boy he had a very small swelling to the inside of the back of his knee on his front leg, no heat and no major swelling. I cold hosed and kept him in the night and next morning swelling had started to travel down his leg but he was only lame in 2/5 strides. Vet obviously called and diagnosed my horse. He's hopefuly coming back into work this weekend assuming of course he is sound.
 
spike123 said:
could it be something like check ligament desmitis. My horse has been off with this and displayed similar symptoms to yours. Mine is 14yrs old and aparantly it's more common in teens/older horses. With my boy he had a very small swelling to the inside of the back of his knee on his front leg, no heat and no major swelling. I cold hosed and kept him in the night and next morning swelling had started to travel down his leg but he was only lame in 2/5 strides. Vet obviously called and diagnosed my horse. He's hopefuly coming back into work this weekend assuming of course he is sound.
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I agree. I think the horse has tweaked a ligament or branch - the downhill reluctance problem could certainly be a symptom as would the on/off lameness! Check ligaments can mimic both of these as does the lack of swelling. The possibility of the swelling that may/may not have been attributed to her wingalls could well be a sprain of the suspensory branch which is a fairly common injury. If you bend her front leg towards her chest as if you are picking out her feet and run your fingers with pressure down the tendon you most probably will get a reaction of pain. The suspensory branch goes down the back of the leg and branches out either side of the fetlock.

I would check to see if there is any slight change in temperature over this area. Stand in front of her and compare both front legs. You will probably see a slight difference in the shape of the fetlock from this angle.

IF it is a ligament branch strain its not the end of the world and has a good prognosis and you can afford to do so, invest in some IceVibe boots and use these AFTER the vet has been out. These are fantastic and will help tremendously towards your horses rehab.

Good luck with the vet.
 
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spike123 said:
could it be something like check ligament desmitis. My horse has been off with this and displayed similar symptoms to yours. Mine is 14yrs old and aparantly it's more common in teens/older horses. With my boy he had a very small swelling to the inside of the back of his knee on his front leg, no heat and no major swelling. I cold hosed and kept him in the night and next morning swelling had started to travel down his leg but he was only lame in 2/5 strides. Vet obviously called and diagnosed my horse. He's hopefuly coming back into work this weekend assuming of course he is sound.
Click to expand...

I agree. I think the horse has tweaked a ligament or branch - the downhill reluctance problem could certainly be a symptom as would the on/off lameness! Check ligaments can mimic both of these as does the lack of any significant swelling. The possibility of the small swelling that may/may not have been attributed to her wingalls could well be a sprain of the suspensory branch which is a fairly common injury also. If you bend her front leg towards her chest as if you are picking out her feet and run your fingers with pressure down the tendon you most probably will get a reaction of pain. The suspensory branch goes down the back of the leg and branches out either side of the fetlock.

I would check to see if there is any slight change in temperature over this area. Stand in front of her and compare both front legs. You will probably see a slight difference in the shape of the fetlock from this angle although with my horse last injury it took three days to materialize at which point when the vet pointed it out which was the soonest I could get the vet out as it wasn't any emergency, the swelling was fairly obvious when stood viewing both fetlocks from the front of the horse.

Not the end of the world, if it is a tendon/ligament strain and you can afford to do so, invest in some IceVibe boots and use these AFTER the vet has been out. These are fantastic and will help tremendously towards your horses rehab.

Good luck with the vet.
 
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Thanks for the thoughts, that is helpful.

There is literally NOTHING to be seen or felt at the moment, other than what I believe to be her original windgalls - but she does have quite hairy Welsh D legs with some feather so that can hide a lot. Also I should have mentioned that she is hard as nails - she didn't object to being ridden with her undiagnosed splint fracture and has had other nasty wounds like a torn eyelid in the past and she hasn't been in the least bothered so I doubt she would ever react to pain. My old vet used to say he could amputate one of her legs and she's still be able to trot up sound - she is just that sort. Which is great until something like this. This does make me sure though that over the poles that day she must have done something that blinking hurt as she never reacts normally. Of course that could have been a stone and this is just a big coincidence but we will see.

I'll read up on those ligaments!

Does anyone know if arthritis in a hind can show as lameness in the diagonal fore? That was my other thought that perhaps the hind is deteriorating - but I don't know it that is how it would manifest?
 
acw295 said:
Also I should have mentioned that she is hard as nails - she didn't object to being ridden with her undiagnosed splint fracture and has had other nasty wounds like a torn eyelid in the past and she hasn't been in the least bothered so I doubt she would ever react to pain. ...
Does anyone know if arthritis in a hind can show as lameness in the diagonal fore? That was my other thought that perhaps the hind is deteriorating - but I don't know it that is how it would manifest?
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Unfortunately many horses hide pain as much as they can :( . This is a survival instinct based on evolution (so much easier sometimes when they are wimps!). I have seen a horse with a chipped bone that didn't appear lame at all - only showed on xray with a non-healing wound. Have also seen another one that was holding its leg off the ground, and it had two drops of blood with a tiny cut; once the area was cleaned up the horse was sound as a bell (that one WAS a wimp!).
in answer to your question would lameness in a hind leg show in the diagonal fore - Yes. Though it doesn't necessarily have to be the arthritis, as it could also be ligament/tendon/bone/cartilage in the hind too.
Best not to ride until the vet has diagnosed, in case whatever it is made worse and delays the horses recovery.
 
acw295 said:
Does anyone know if arthritis in a hind can show as lameness in the diagonal fore? That was my other thought that perhaps the hind is deteriorating - but I don't know it that is how it would manifest?
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Most certainly a horse with hind limb pain will be overcompensating onto the forehand but this theory doesn't make entirely sense to me as this wouldn't suddenly manifest itself during a trot pole exercise, as it would be something that has shown signs of deterioration for sometime - a gradual increase in decreased stride length, dragging the toes through the ménage surface, continual swapping of hind legs in canter, difficulty in bringing the hocks underneath, giving the appearance of 'leaving a leg behind' when in trot, clipping the road surface whilst trotting on the road, refusal of jumps (where the hocks have to come into play in order to push off over a jump), etc.

I am not a vet but from your description its sounds almost certain that your horses injury has happened through overstretching the limb through the poles and some kind of tendon/ligament strain issue has resulted.

If the vet thinks there may be possible spavin in your horses hocks then they will want to see your horse is trotted up on a hard surface and will watch the horse move away from behind so they can see if there is any alteration in foot placement (hock pain causes a foot to land differently in order to alleviate pain through that joint). They will possibly want to see your horse lunged on grass or hard standing, and also in W,T and C on the lunge in the school on both reins. As a rule of thumb soft tissue damage reacts to a soft surface, whereas joint pain reacts more to a harder surface. He/she will possibly do flexion tests in order to reach a diagnosis.

I agree with Wikiwi that the horse may have a strain in the hind legs and it might not be bone spavin. Your vet will advise accordingly.
 
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applecart14 said:
Most certainly a horse with hind limb pain will be overcompensating onto the forehand but this theory doesn't make entirely sense to me as this wouldn't suddenly manifest itself during a trot pole exercise, as it would be something that has shown signs of deterioration for sometime - a gradual increase in decreased stride length, dragging the toes through the ménage surface, continual swapping of hind legs in canter, difficulty in bringing the hocks underneath, giving the appearance of 'leaving a leg behind' when in trot, clipping the road surface whilst trotting on the road, refusal of jumps (where the hocks have to come into play in order to push off over a jump), etc.

I am not a vet but from your description its sounds almost certain that your horses injury has happened through overstretching the limb through the poles and some kind of tendon/ligament strain issue has resulted.

If the vet thinks there may be possible spavin in your horses hocks then they will want to see your horse is trotted up on a hard surface and will watch the horse move away from behind so they can see if there is any alteration in foot placement (hock pain causes a foot to land differently in order to alleviate pain through that joint). They will possibly want to see your horse lunged on grass or hard standing, and also in W,T and C on the lunge in the school on both reins. As a rule of thumb soft tissue damage reacts to a soft surface, whereas joint pain reacts more to a harder surface. He/she will possibly do flexion tests in order to reach a diagnosis.

I agree with Wikiwi that the horse may have a strain in the hind legs and it might not be bone spavin. Your vet will advise accordingly.
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We've had none of the issues described above. She was seen by her chiro just before the pole incident who described her as being in very good shape and she only commented that she shows very slight stiffness in the off hind when doing stretches with it, but in a way she'd expect for an 18 year old. Her other hind she commented was incredibly flexible for her age, as was the rest of her. Schooling wise she works well on both reins, no toe dragging, no issues with canter at all, no change in stride length. Nothing to ever suggest her hocks are giving her any grief at all, in fact she was working the best she had been in years which is such a shame! We don't really jump so can't comment on that as untested though. So I think it is probably only the forelimb issue.

Unfortunately she doesn't lunge so they aren't going to be able to see her lunged in any pace. I can ride her but not lunge her - she doesn't know how and just panics, broncs, canters around frantically and then rears in my face - completely distressed. I have never needed to lunge her so it has never been something I bothered to try and fix. So they are going to have to be creative!
 
Small update

There is a small area of swelling (a bit bigger than my thumbnail) above her fetlock on the outside of leg that is now evident when she has been stood in - but disappears when she has been turned out - its very squishy and she is happy for me to touch it (but she is mega stoic as I said before). I don't think it is any warmer than the other leg - if it is it is negligible, when she comes in from the field both legs feel equally cold. At the moment she comes in during that day, out at night as this is her usual summer routine for fat management. Would swelling associated with ligament or tendon issues usually improve with turnout or should it be constant/worse after movement? I would have thought the latter? Her legs have always filled to some extent when stood in - but this new area is in additional to the usual minor filling that she always gets from standing in.

I am hoping vet will arrive late enough in the day to see the swelling in case it is relevant!

Also, took her in the school inhand for 5 mins - looks sound (to the uneducated at least) on either rein but then she only went lame out hacking when pushed. So not sure that tells me much. I was more curious than anything to see if she were suddenly hopping on a surface. But alas no!

Roll on Monday...
 
The tendon sheath is in that area it will often swell when a tendon or ligament has an injury or strain, I wouldn't ride anymore until the vet has been as you could be doing further damage which you don't want most soft tissue injuries need rest to heal, good luck with the vet.
 
Pinkvboots said:
The tendon sheath is in that area it will often swell when a tendon or ligament has an injury or strain, I wouldn't ride anymore until the vet has been as you could be doing further damage which you don't want most soft tissue injuries need rest to heal, good luck with the vet.
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Thanks, yes not ridden since last Weds when she was visibly lame after trotting, which is when I booked the vet. She looks fine just being led about/trotted up annoyingly but not chancing it. I did take her in the school in hand for a few strides on each rein - just to see if the lameness was anymore obvious on the surface - it wasn't. No plans to sit on her though unless vet tells me to.
 
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applecart14 said:
Any update on this please OP?
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Vet not until Monday sadly so long wait yet. It's driving me bonkers! But couldn't take time off this week unless it is a dire emergency (I have a long commute so it would have required a whole day home) - am off work all of next week and as the issues started 1 May I figured that another week wouldn't make any difference, especially as no visible lameness or discomfort. I also then have the benefit that if they need a follow up appointment or want to admit her for a work-up at the vets I have all week to try and load her with no time pressures.
 
So the verdict is- Tenosynovitis to near fore. She trotted up sound but lame after flexion on that leg only. The slight swelling I felt on and off is relevant. There is some inflammation above fetlock near her windgalls and also below where tendon goes into hoof.

10 days of bute (2xdaily) plus ridden walk hacking and hosing after exercise. She can have her usual turnout though as they are a quiet herd (so in by day, out at night as she's in fat club).

She could've had steroids but vet (and me!) not keen due to lami risk, so bute instead which will take longer but will still hopefully work. If worse or no better after 10 days they'll explore other options inc medicating the tendon sheath, but as she is barely lame they want to give it time instead to start with.

Vet optimistic that tendons may be ok although can't rule that out yet.

Relieved much, not nice to know that she is injured but also pleased its not something catastrophic and also that I am not mad and there is an issue.

Thanks all for your comments, will update with progress!
 
Here is an interesting read about it http://www.novobrace.com/tendonitis/

Hope she gets better soon, lots of icing or hosing after riding! Vets these days are more open to exercise after an initial short period of rest as they feel it is more beneficial to tendon healing exposing the tendon to a certain amount of controlled exercise and load bearing.
 
applecart14 said:
I agree. I think the horse has tweaked a ligament or branch - the downhill reluctance problem could certainly be a symptom as would the on/off lameness! Check ligaments can mimic both of these as does the lack of any significant swelling. The possibility of the small swelling that may/may not have been attributed to her wingalls could well be a sprain of the suspensory branch which is a fairly common injury also. If you bend her front leg towards her chest as if you are picking out her feet and run your fingers with pressure down the tendon you most probably will get a reaction of pain. The suspensory branch goes down the back of the leg and branches out either side of the fetlock.

I would check to see if there is any slight change in temperature over this area. Stand in front of her and compare both front legs. You will probably see a slight difference in the shape of the fetlock from this angle although with my horse last injury it took three days to materialize at which point when the vet pointed it out which was the soonest I could get the vet out as it wasn't any emergency, the swelling was fairly obvious when stood viewing both fetlocks from the front of the horse.

Not the end of the world, if it is a tendon/ligament strain and you can afford to do so, invest in some IceVibe boots and use these AFTER the vet has been out. These are fantastic and will help tremendously towards your horses rehab.

Good luck with the vet.
Click to expand...

The "on off lameness" struck a cord with what's happening to my guy. He's 19 and 1m78(17hands?), in great shape but fairly old. He never had an extended showjumping career so really as never been over worked. Am going to run out and check behind the knee....Also this may explain why he could stand on it(as I wrote in another thread on this subject.)

thanks ...rr
 
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