Lameness investigation options a WWYD

[SussexbytheXmasTree]

My 14yr old DWB has a graded 3/10ths left hind lameness. He had a lameness work-up yesterday. History is declining performance this summer with reluctance to really work forward. He’s a pretty chill chap that conserves energy, currently has a bit of a grass belly and the hot weather being possible factors masking lameness as a reason for this. Then he had a sudden marked lameness during the second of two Prelim tests I did a couple of weeks ago.

Vet gave me two options. 1) bone scan but I’d have to wait 2-3 weeks for appointment, or 2) traditional nerve-blocks which he’s currently booked in for Monday to be done over 2-3 days. I could potentially cancel this before Monday.

Vet I think but didn’t say preferred bone scan. I know this could give a broader picture and possibly be better if multiple issues. Obviously it’s really expensive and isn’t ruled out to be done if the nerve blocks are inconclusive. I’ve had them done on previous horses so know the drill.

So would you wait for bone scan or crack on with blocks on Monday?

 

[Tiddlypom]

Blocks to start with as part of a conventional lameness work up.

Bone scans are now known not to be the wonder diagnostic tool that they were initially believed to be. Bone scan as last resort if nothing shows conventionally.

Hope that whatever it is proves to be readily fixable. Good luck.

 

[ycbm]

I'd take some persuading to go straight for a bone scan when so many horses of that age will have simple hock arthritis that can be treated on the day.

Is he reacting badly to SI manipulation or something?

 

[RHM]

I would only personally treat something that responded to a nerve block.

Bone scans could throw up a whole host of things that aren’t actually making him lame.

Really hope it’s quick and cheap to fix though!

 

[millitiger]

I'd get cracking with nerve blocks.
If you have a clear limb lameness, it doesn't sound like you need a bone scan (to me) which is more used when vets don't really have a clue where to start.

 

[Melody Grey]

Could you book in a bone scan but cancel without charge well in advance if the nerve blocks are successful?

I wouldn’t personally go straight to a bone scan- if you’re insured, might be worth checking with your insurer. I’d think they’d want nerve blocks first too before authorising bone scan?

 

[Patterdale]

I’d put steroids in the hocks and see if it improves. If it does its hocks. If it doesn’t you’ve ruled out hocks for the price of a nerve block.

I certainly wouldn’t go for the bone scan. If anything I’d do nerve blocks, which will be more accurate than the scan. Scans can throw up all sorts that look significant but isn’t actually what is bothering the horse. If you let the horse tell you when it stops hurting you can then treat the right place.

But like I say, I’d medicate the hocks first because it’s usually hocks.

 

[SussexbytheXmasTree]

I'd take some persuading to go straight for a bone scan when so many horses of that age will have simple hock arthritis that can be treated on the day.

Is he reacting badly to SI manipulation or something?

No he didn’t mention that. My previous horse had SI issues and his lameness issues don’t feel like that to me. I asked what his thoughts are around just treating for hock arthritis to see if that worked and he was reluctant as it has some risks and without diagnosis a potentially unnecessary one. He’s apparently seen a few where it has gone wrong. He also said that it then might exclude from insurance later on even if not the issue. Obviously I’m relying on his professional opinion

 

[Patterdale]

No he didn’t mention that. My previous horse had SI issues and his lameness issues don’t feel like that to me. I asked what his thoughts are around just treating for hock arthritis to see if that worked and he was reluctant as it has some risks and without diagnosis a potentially unnecessary one. He’s apparently seen a few where it has gone wrong. He also said that it then might exclude from insurance later on even if not the issue. Obviously I’m relying on his professional opinion

I’d say yes thanks for your opinion I do understand but can you just medicate the hocks please and I’ll write you a cheque

Nerve blocks and sedating for bone scans can go wrong too, every procedure comes with risk but medicating hocks is pretty normal and straightforward stuff.

 

[SussexbytheXmasTree]

I’d say yes thanks for your opinion I do understand but can you just medicate the hocks please and I’ll write you a cheque

Nerve blocks and sedating for bone scans can go wrong too, every procedure comes with risk but medicating hocks is pretty normal and straightforward stuff.

Maybe as a compromise I could say block the hock first then medicate if it’s positive?

 

[Tiddlypom]

Don't take shortcuts, it's honestly not worth it. Block the foot first and then work up the leg as per the standard workup.

It may well be hocks, but it could also be a number of other things.

 

[AandK]

I would not want to risk medicating a joint without knowing that was the issue personally. I would crack on with the nerve blocks, I'd only bone scan if you don't know which leg/where the issue is.

 

[Boulty]

If you’ve got a fair idea of where the lameness is coming from then I’d crack on with blocks etc. If absolutely no idea where lameness coming from then would bone scan but you’d likely have to follow that up with blocks to confirm anyway.

 

[Michen]

I would never put steroid into the joint without being pretty sure if not certain it was causing a problem.

Definitely nerve blocks.

 

[Roxylola]

My understanding of blocks is its from x down so blocking hocks won't rule out foot lamenesz

 

[Michen]

My understanding of blocks is its from x down so blocking hocks won't rule out foot lamenesz

You work your way up the leg, typically. At least my vet always has.

 

[Tiddlypom]

My understanding of blocks is its from x down so blocking hocks won't rule out foot lamenesz

It's foot first then work your way up.

 

[Goldenstar]

Starting with the nerve blocks would be my choice
I have seen in the past workups started with a bone scan when it was a case of if the bone scan shows a lot of issues they would just give immediately if they are used like that it’s sometimes an economic way of deciding of not continuing
I think it’s likely a conventional work up will find you an answer quickly.
3/10 lameness before flexion does not usually take much tracking down

 

[sbloom]

It's foot first then work your way up.

Absolutely, because it blocks all the way down from the blocking site which is what Roxylola was saying.

I would have a full work up but, as always, see any medication as a window to address movement patterns as most of these lamenesses are from repetitive strain (quote from Gillian Higgins).

 

[PinkvSantaboots]

Have proper nerve blocks where they start at the hoof and go up then depending on what is found they then x ray and scan the suspect areas if any, I've always had this for all my horses work ups and always had good diagnostic results, it may throw up more than one issue but at least you know and can treat it all in one go.

If you start just treating random bits of a leg and there is something else going on you won't know and you will probably still have a lame horse.

 

[PinkvSantaboots]

I’d say yes thanks for your opinion I do understand but can you just medicate the hocks please and I’ll write you a cheque

Nerve blocks and sedating for bone scans can go wrong too, every procedure comes with risk but medicating hocks is pretty normal and straightforward stuff.

But what if the suspensories are shot or arthritis in the coffin joint the horse will still be lame, most work ups I have had done rarely throw up just one issue especially in an older horse.

Injecting joints has its risks just like anything medical.

 

[Tiddlypom]

I'd suggest getting the hind suspensories scanned anyway while he's there. It's easy enough to do. Any hind limb lameness can adversely affect them so a quick check is wise.

 

[PinkvSantaboots]

I'd suggest getting the hind suspensories scanned anyway while he's there. It's easy enough to do. Any hind limb lameness can adversely affect them so a quick check is wise.

Agree and the si joint often suffers with things going on in the hind limbs as well.

 

[SussexbytheXmasTree]

You work your way up the leg, typically. At least my vet always has.

That’s always been my understanding.

 

[ycbm]

My understanding of blocks is its from x down so blocking hocks won't rule out foot lamenesz

My vet explained you can't do that because the amount of anaesthetic required to block the stifle is so huge that is drifts down the leg and can anesthetise the wrong part.

I thought they always blocked foot upwards.

We blocked mine hocks first because everything was pointing to them and in the end it was the foot that was injured and the cause was the main fetlock bone.
.

 

[SussexbytheXmasTree]

Well it seems that a proper work-up with nerve blocks is the preferred option which is what I’d thought was the best option but had some self-doubt. It’s luckily been 10yrs since I’ve needed one done and I am second guessing myself. It’s always good to have a range of experiences and knowledge to consider. Thanks everyone for your responses it’s much appreciated.

 

[SussexbytheXmasTree]

I'd suggest getting the hind suspensories scanned anyway while he's there. It's easy enough to do. Any hind limb lameness can adversely affect them so a quick check is wise.

I’ll ask about it again when I take in on Monday. He had an affiliated jumping career starting competition at 4yrs old prior to me buying him 5yrs ago so I did mention suspensories to the vet yesterday.

 

[Xmasha]

Nerve blocks first without a doubt .
Having just gone through it with my mare . They start at the bottom and work up .
We were lucky , first injection worked so we know the issue is in the hoof . Then an X-ray to see what’s happened . Fortunately hers was just a strain .

If you think it’s stifle ask them to scan that.

Good luck

 

[Lady Jane]

I understood nerve blocks starting from the bottom working up was the best approach. Then it depends what you find. Usually ultra sound of the affected area and x-rays. As someone else said, whole body bone scan when these reach no conclusion. Steriods into joints is fine when you know that joint is the problem

 

[SussexbytheXmasTree]

Absolutely, because it blocks all the way down from the blocking site which is what Roxylola was saying.

I would have a full work up but, as always, see any medication as a window to address movement patterns as most of these lamenesses are from repetitive strain (quote from Gillian Higgins).

Agree absolutely he already has regular osteopath and Bowen treatment plus I’ve tried a fair few exercise therapies since I’ve had him. He was quite crooked and weak looking when I bought him although he did pass a 5-stage.