Lameness investigations, what to try next?

bounce

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My 5 year old mare developed swollen hind fetlocks and slight thickening of annular ligaments so was referred to a veterinary hospital for further investigations. She was lame on her right hind (2/10) which was the opposite one to the worst of the swelling and the pain was nerve blocked to high suspensory and stifle although no damage was shown at either location on ultra sound, MRI or xray. Only 50% improvement in lameness was achieved when she was nerve blocked and when this happened she then went lame in front but only on a circle on a soft surface. She shows a real lack of push from behind when on the lunge and I've noticed she struggles in trot uphill. She seems to be bilaterally lame behind with the right hind being most affected.
Vets decided to medicate hocks and send her home with a 3 month rehab programme starting at 30 mins walking 4 times a week. The fetlock swellings have improved after a week of box rest and very little work. But she still has a minor toe drag whilst going downhill and I still think she looks lame on the right hind 10 days on from the steroid injections.

I still feel something is very amiss which hasn't been picked up yet.
I had my mctimoney chiropractor visit her and she picked up that she was extremely sore at the base of the neck. She was very unhappy to have the physio work done on her and was bracing against each movement and pulling faces which is very unlike her. In a previous visit she just stood there and enjoyed the work done on her.

Her insurance is almost maxed out but I am willing to pay to get to the route of the problem.
She has fairly rubbish feet in that she has low heels and have to be managed well to ensure they do not get long in the toe and her confirmation is not brilliant in the fact that she has quite straight hocks. I have also noticed she can be fairly footy over uneven ground.

My question to all lameness gurus out there is where would you look next to try and locate the main cause of her issues? Would you look at neck first or feet first?
 

SEL

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Could you get a bone scan through on insurance? I really wish I'd had that done 2 years ago when I first felt something wasn't right, but vets were convinced hocks.

I'm having a look a thermography too. My vet works with one of the companies and says it is "useful". Given the age of yours I'd go back to the vets and push a bit more on the investigations. I wish I had!!
 

ycbm

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Does she have much TB blood? There's a congenital problem with C6/7 causing instability in the base of the neck which has recently been identified and is turning out to be quite common. So if she has TB blood or Warmblood with TB lines, I'd get some neck X rays. The front end instability could easily have caused hind end issues over time.


https://thehorsesback.com/c6-c7-malformation/
 

bounce

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I have asked vets to have a rethink about what else can be done to look into the problem as I'm not convinced on current rehab which is only going to improve hind lameness slightly considering nerve blocks were only 50% improvement. I am only on week 2 of rehab so not very far in but just can't help thinking it is not the main cause of the problem and I'm just wasting the next 3 months.
Having ridden her last night which was the first time after her physio session she felt a little more settled that last week where she was like a ticking time bomb to ride but is still wanting to stretch her neck down an awful lot which I don't feel is right.
Bone scan won't be covered on insurance but I will happily pay if it is the right way to go, just wondering if it would be cheaper to just get a set of xrays of neck, back and front feet though as even if those areas show as hot spots won't they will still need xraying or can the bone scan actually show the images clear enough to see the problem? I thought it was just a tool to show hot areas to further investigate?
 

bounce

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Does she have much TB blood? There's a congenital problem with C6/7 causing instability in the base of the neck which has recently been identified and is turning out to be quite common. So if she has TB blood or Warmblood with TB lines, I'd get some neck X rays. The front end instability could easily have caused hind end issues over time.


https://thehorsesback.com/c6-c7-malformation/

This is really interesting, thank you. She is Connemara x Irish TB/ID so a possibility I guess.
 

little_critter

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In my limited experience I believe wanting to stretch the head / neck down indicates back pain (could be primary or could be secondary to a limb problem).
Bone scans don't tell you what is wrong, they just show the hot spots as you say. They tell the vets where to x-ray / investigate. But a hot spot on a scan doesn't neccessarily mean there is a real physical issue in that area. I've had scans come back with hot spots but x-rays revealed nothing of concern in that area.
 

SusieT

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If you haven't got a diagnosis of where the problem is I would agree a 3 month rehab is not necessarily the thing to do- how good was your vet - can you get a second opinion nerve block sessions?
 

ester

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I think if I were you I'd bone scan as atm given the front/back/only 50% improvement issues I don't think it's very clear where to start.
I don't quite understand the decision to medicate the hocks.
 

bounce

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I think if I were you I'd bone scan as atm given the front/back/only 50% improvement issues I don't think it's very clear where to start.
I don't quite understand the decision to medicate the hocks.

Medicating the hocks is to alleviate any inflammation at the insertion point of the suspensory as that blocked out 50% improvement. I'm not convinced it is going to help as if blocking it only improves by 50% then steroids are only going to give the same result also. I suppose they are hoping that a controlled exercise programme will help any other issues but in my view it will only get worse again when the work is increased unless the main problem is located and resolved.
 

ycbm

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I think if I were you I'd bone scan as atm given the front/back/only 50% improvement issues I don't think it's very clear where to start.
I don't quite understand the decision to medicate the hocks.


This is where would go if you have £1200 or so to spend. If not I would x-ray the neck and nerve block the front feet. I wouldn't x-ray the front feet to start with because front foot lameness is only rarely a bone issue and you could easily get a false positive on bone changes.


..
 

sam72431

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I'm not sure if it's the same but my mare has had a niggling lameness kind of is it isn't it type started in Feb vet out box rest etc sound gradual build up of work and been sound. Shes had physio as well and found soreness in her neck which was correcting in about the region you are saying. Anyway been very happy then all of a sudden 3 or 4 10ths lame a few weeks ago. Found thickening of annular ligament we opted for surgery on vets advice even though a week following the steroid injection she was completely sound!

Op was yesterday and thank god we went in 2 3-4cm tears in ddft, manica removed and significant mineralisation and debris. This all on a sound horse! Vets are astounded at how sound she is considering the amount of damage.

Now I'm not saying yours has this but on scan they had no sign of any damage other than annular ligament as it is under the tendon sheath and there was nothing significant or worrying!

I think sore neck compensated for her leg and reason for long story is I would really look into it more especially if your gut is telling you it's not right! You know your horse the best! Hope it's good news for you 😇
 

Theocat

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I would be questioning whether it's a front foot issue, causing the horse to tense and hold its weight in all the wrong places...
 

Melody Grey

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Do you have access to thermal imaging? Might give an indication of where to look next? Although you're seeing tension in the neck, I'd also want to be looking for KS and SI issues here I think- maybe a full spinal x ray? I've never had a bone scan done, so can't comment on that but it sounds expensive- wouldn't x rays be cheaper and perhaps narrow it down?

I agree with others that front feet could be a cause, but would investigate spine first personally.
 

hopscotch bandit

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Does she have much TB blood? There's a congenital problem with C6/7 causing instability in the base of the neck which has recently been identified and is turning out to be quite common. So if she has TB blood or Warmblood with TB lines, I'd get some neck X rays. The front end instability could easily have caused hind end issues over time.


https://thehorsesback.com/c6-c7-malformation/
I agree with YCBM. My horses problems stem from a neck problem at C7/T1 which has caused neuro issues.
 

ihatework

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These ones are a PITA (sorry!)
Depending on the horse and my position at the time I would either swallow vets costs and bone scan then do what is needed after - I think you would need to be prepared to set aside at least 2k, and you need to be prepared that you may be no further forwards.

Or I might be inclined to just whip the shoes off and pop the horse in the field for a year, then see where you are. You might still need to spend the money and be a year behind but sometimes whatever is going on can just settle.
 

Goldenstar

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I agree with ihatework many horses respond to time in the right sort of field it’s unfashionable now just to turn away ,insurance has lead to a rush to treat and because we can do more we think we must .
I would much prefer to have an answer before I turned away though .
Turned away horses need company and space as in big fields and undulating fields with not too much grass that’s difficult for many people to achieve they also need regular foot trimming can be as much as every three weeks .
 

bounce

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So today I had a second opinion and after some work ups we xrayed the neck.
It wasn’t the answer I was looking for but we did get a definitive diagnosis of wobblers caused by a bone spur halfway down her neck.

Utterly gutted as there’s nothing that can be done but at least I pushed for answers when I knew things weren’t right.

Heartbroken 😭
 

Melody Grey

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Oh Bounce, sorry to read this. I know it’s not much consolation, but at least you know and can stop ‘searching’ for answers and what ifs both literally and psychologically now. Xx
 

ycbm

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So today I had a second opinion and after some work ups we xrayed the neck.
It wasn’t the answer I was looking for but we did get a definitive diagnosis of wobblers caused by a bone spur halfway down her neck.

Utterly gutted as there’s nothing that can be done but at least I pushed for answers when I knew things weren’t right.

Heartbroken 😭


So sorry. I had a wobbler. It's heartbreaking that they look so well and are so broken.
 

ihatework

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Bounce that’s a really crappy outcome I’m sorry.

It might be the wrong thing to say when you are feeling so low about it but, personally, having had a variety of horses go wrong over the years the easiest ones to come to terms with are the ones with a definitive and damning diagnosis. There are no ‘what ifs’.
 

Hormonal Filly

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I am so sorry to read this, but at least you have a diagnosis now.
What are your plans?

My gelding has chronic arthritis in his lower neck, hes only 9.. pushing on his spinal cord as well but only slightly, although he was tripping and acting slightly 'wobbler' like. He had it medicated and 5 months of good work only to suddenly start going worse than before. I've decided to retire him for as long as I can while hes pain free just grazing.
 
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hopscotch bandit

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Bounce, so sorry to hear your horses diagnosis. Been there, its horrible, but at least you have a diagnosis and can reach a decision about the future, hard as that is.
 
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