Video Lameness investigations, what would you do (slo-mo video)

[BBP]

I have recently been posting about BBP and his issues getting up from rolling. I wondered what you would do if it was your horse?

The horse has a history of sacroiliac issues. There are still some residual issues but the osteopath is happy with how he is progressing and the sacroliliac and hocks are things we always keep an eye on, so for this post I'm looking past those and at the front end, which is now the focus of some investigations. When moving he wants to land toe first, and he does not want to fully extend the forelimbs from the knee and fetlock. You can clearly see this in the first part of the slow motion video, especially if you watch the off fore, but it is both. This video is taken whilst on a high dose danilon trial, so painkillers have not 'fixed' it. There should be a few more inches to each stride. When getting up from rolling he does not want to extend the forelimbs and will dig the toes in and get up with his knees and fetlocks bent, causing him to fall occasionally (last part of video). He camps under when standing (I'm now seeing this same posture in loads of photos of other peoples horses!). This is improved when wearing boots and pads, he stands under himself normally with these on. He also walks and trots out more happily with boots and pads on (can go from ears pinned and grumpy when asked to trot along barefoot to ears forwards and happy as soon as boots and pads are on). Occasionally I will see him stand with one front leg off lock, so knee slightly flexed.

I have had his feet x-rayed and they show nothing majorly significant as far as vet is concerned. Toes too long but that was in part due to the virus meaning we went longer between a few trim cycles. But trimming facebook page has commented on deep bars putting pressure under the coffin bone and deep central sulcus possibly also causing pain. Obviously there could be soft tissue damage not visible on the x-ray. Vet still thinks its higher up, perhaps arthritic changes in knees or fetlocks, or even in the neck and that that is why he lands heel first as he doesn't want to straighten the leg. I still feel it could be the foot and that he is trying to take the weight off the heels. In an ideal world we would nerve block, but the horse is NOT good to do this, and it took about 5 or 6 people to hold onto him last time, not appropriate during coronavirus.

Vet has listed a few options:
1) run a few trim cycles, focusing on bringing the toe back, reducing the depth of the bars/collateral grooves and central sulcus. Use boots and pads the whole time in between to encourage correct use of the heel and develop the digital cushion. Field rest/in hand walk work only. Put on danilon to reduce inflammation

2) X-ray the knees and fetlocks to check for any degeneration, medicate as needed with HA (not steroids due to laminitis risk).

3) MRI knees and fetlocks to give the most complete picture possible.

(another option is to take a punt and just medicate the knees, but i'm not happy doing this without knowing this is the cause of the issue, and I'm still not convinced)

Horse is not insured.

I'm tempted to x-ray just for piece of mind to discount any joint changes, and then to try a few months of boots and pads and trim to get the feet 100%. I wouldn't do any box rest or surgical interventions with this horse, so any further management would be linked to field rest anyway, so other than giving more definitive answers I'm not sure the expense of an MRI is worth it, but I don't want to do the wrong thing by him.

The possibility of it being an issue in the neck has also occurred to us. Not sure if they could do neck x-rays at the yard too, or if that has to be done at the vet hospital?

Many thanks!

 

[Goldenstar]

Tough times
Camping under can be a sign of significant soft tissue damage in the hind limbs , the dreaded PSD .
I would be wanting some soft tissue scanning to the hind hocks and fetlocks done .

 

[TheMule]

Have you scanned his hind suspensories? I think he is lamer behind than in front

 

[be positive]

The thing that caught my eye was his near hind and how low the fetlock went, the front end could be caused because of issues behind.

 

[BBP]

Tough times
Camping under can be a sign of significant soft tissue damage in the hind limbs , the dreaded PSD .
I would be wanting some soft tissue scanning to the hind hocks and fetlocks done .

I’ll ask about that, thank you. The only thing that makes me doubt this is that he had hocks and hinds investigated a couple of years ago (turned out to be a fractured splint) and all were good, and he was camping under back then as well looking back at old photos (I sound like a terrible owner, but we have always been so focussed on sacroiliac, hocks, stifles etc that we never looked further forwards.)

If PSD at the back do you think it would be instantly improved by the boots and pads?

 

[milliepops]

I really feel for you you've certainly been through the mill together. I think, given the options you have outlined I would also probably do some x rays of the forelegs as it's been suggested as a possibility - rule it out if nothing else, and the pursue the feet as you have suggested. Might the feet be an unrelated issue? Sounds like they need improving in any case so nothing lost by addressing them anyway. However I agree with TM he does look off all round

I've only had a neck x rayed at the horspital. My horse with arthritis in her neck presents as unlevel behind when challenged by surface or lunged and occasionally lame in one front leg though there is nothing to be found in any of the limbs and it's all coming from the neuro issue.

 

[BBP]

Looks like a few people saying similar. I shall definitely add it to my list of things to ask the vet about.

He has done the toe drag behind even when tendons scanned ok and hocks xrayed. I don’t know much about psd so will get informed.

 

[Goldenstar]

If it adjusted his gait and took the pressure off the suspensories yes it might the effect would be likely to be short term .
Have you ever had issues with thrush in his heels ?

 

[meleeka]

No advice but wanted to say what a great video for diagnostic purposes. You can really see the issues getting up as well with this one. I hope you’ve sent this to your vet.

 

[CanteringCarrot]

There could be a few layers to this. Perhaps there is something with the suspensories AND feet. Or perhaps there is one issue that the horse compensated for which then led to a myriad of other issues. Or perhaps there are multiple unrelated issues. Fun, eh?

Of course make sure the feet are squared away balance wise, as it does sound like there could be some heel pain there. So I'd definitely go that route.
I'd also opt for the x-rays and possibly an ultrasound of the suspensories if I could swing it. Depends on how far down the rabbit hole you want to go.

 

[BBP]

I really feel for you you've certainly been through the mill together. I think, given the options you have outlined I would also probably do some x rays of the forelegs as it's been suggested as a possibility - rule it out if nothing else, and the pursue the feet as you have suggested. Might the feet be an unrelated issue? Sounds like they need improving in any case so nothing lost by addressing them anyway. However I agree with TM he does look off all round

I've only had a neck x rayed at the horspital. My horse with arthritis in her neck presents as unlevel behind when challenged by surface or lunged and occasionally lame in one front leg though there is nothing to be found in any of the limbs and it's all coming from the neuro issue.

Thank you. He is certainly a challenge. Lucky for him he doesn’t have to do a job other than be a happy horse. He’s still a bright bouncy chap but I know something is hurting him so I need to do more for him. As you say, feet can always be improved but they may be a red herring unrelated to or caused by something else.
The neck isn’t something I have thought of before but given he spends his whole life staring at monsters and galloping around falling over it wouldn’t be a shock if there was an issue.

 

[milliepops]

suspensories so often go hand in hand with SI issues, I definitely agree it would be worth checking those carefully as that may just have been lurking under the radar for a while and then if his feet aren't 100% that might be the thing that has made it all seem worse and may still account for the weakness getting up. The PSD cases I have known have developed a bit of a short shuffly way of going which looks a bit similar. How is his canter?

 

[ihatework]

I think before I dived head first into multiple investigations I would want to know what my budget was and what my expectations of the outcomes are / how far I would be prepared to go to treat (if something could be pinpointed, which isn’t a given).

 

[quizzie]

As I have suggested before.......I would start with the neck....it needs to be done by someone experienced in interpreting cervical radiographs. ...that looks so typical of weakness and variable awareness of hind limb, plus careful use of forelimb which tie in with pressure on the spinal cord in the neck region.
Basically in the neck, the hindlimb nerves are on the outside of the "bundle". ...so their functioning is affected first. The real time video shows hindlimb being slightly left out the back each stride..possibly due to slow neurological transmission. The forelimb is taking the strain more to stabilise.

To put it at its simplest...there are signs that the hindlimbs are not working properly....there are signs that the forelimbs could be involved.....now you could have multiple issues, but it is more likely that they derive from one source...the neck.

I have seen horses getting up from rolling like that before.....it was proven to be neck in both cases.

 

[BBP]

I think before I dived head first into multiple investigations I would want to know what my budget was and what my expectations of the outcomes are / how far I would be prepared to go to treat (if something could be pinpointed, which isn’t a given).

This is the thing. I will always find the money for him, although now personal circumstances are challenging. But I wont do any surgical intervention or box rest with this horse. And he doesn’t need to be anything other than a happy field pet. So I don’t know how much to do. I know with my own health I spent thousands on private tests to be told nothing definitive, and yet I still definitely had problems. I’m just really confused as to what to do for the best for him.

 

[BBP]

As I have suggested before.......I would start with the neck....it needs to be done by someone experienced in interpreting cervical radiographs. ...that looks so typical of weakness and variable awareness of hind limb, plus careful use of forelimb which tie in with pressure on the spinal cord in the neck region.
Basically in the neck, the hindlimb nerves are on the outside of the "bundle". ...so their functioning is affected first. The real time video shows hindlimb being slightly left out the back each stride..possibly due to slow neurological transmission. The forelimb is taking the strain more to stabilise.

The hind limbs left behind are something my instructor has commented on before, that they trail behind more than they step under, it’s not an equal, rhythmical stride.
The neck is definitely now on my list. Vet did mention it when she visited so I will raise it again.

 

[milliepops]

As I have suggested before.......I would start with the neck....it needs to be done by someone experienced in interpreting cervical radiographs. ...that looks so typical of weakness and variable awareness of hind limb, plus careful use of forelimb which tie in with pressure on the spinal cord in the neck region.
Basically in the neck, the hindlimb nerves are on the outside of the "bundle". ...so their functioning is affected first. The real time video shows hindlimb being slightly left out the back each stride..possibly due to slow neurological transmission. The forelimb is taking the strain more to stabilise.

this is how mine was explained to me.

The neck isn’t something I have thought of before but given he spends his whole life staring at monsters and galloping around falling over it wouldn’t be a shock if there was an issue.

yes it's a bit of an "out there" thing but quizzie has explained it well I think. I now see other things in mine, she's also a montster-spotter and will spook so hard she loses her footing in a way that seems unusual compared to other horses. she looks where she's going carefully - I just thought she was clever She will also be on high alert, with her pulse visibly thumping, but be resting a hindleg... weird mix of ready to go and yet not aware of her own body. we do have treatment options available but at the moment I am not pursuing them as she does not appear to be negatively affected in any significant way, similar life aims to BBP: be a happy horse doing her own thing.

 

[ycbm]

I wish we had more of the whole horse, because I think there is something very odd about the way he sticks his neck out straight when he drops his head.

I'd go for the neck first (but then after my recent experiences, I would, wouldn't I? ?).

 

[CanteringCarrot]

I find the neck thing interesting. It could very well be a neck issue with this horse.

I've been hearing more and more about neck issues recently and it makes me wonder if they've always been there, but we've just starting paying attention. Or if they've just become more common. I don't know.

I just want to say, OP, that I really respect you trying to do your best for this horse.

 

[BBP]

suspensories so often go hand in hand with SI issues, I definitely agree it would be worth checking those carefully as that may just have been lurking under the radar for a while and then if his feet aren't 100% that might be the thing that has made it all seem worse and may still account for the weakness getting up. The PSD cases I have known have developed a bit of a short shuffly way of going which looks a bit similar. How is his canter?

His canter is crap to be honest, has been his whole life, even before sacroiliac issues and after hocks and hindlimbs investigated and all clear. He has no engine at all. I’d always assumed it’s me being a crappy rider/trainer but I see other young horses with such lovely natural canters. In the field mine has always either gone flat out (and often fallen over, hence sacroiliac constantly raising its head) or he has generally just done a big trot, he rarely just canters.

 

[BBP]

I wish we had more of the whole horse, because I think there is something very odd about the way he sticks his neck out straight when he drops his head.

I'd go for the neck first (but then after my recent experiences, I would, wouldn't I? ?).

I’ve got loads of videos but most are me videoing myself so a bit bumpy. I’ll see what I can find. The slow motion trot one was edited so I may have more of it.

 

[Goldenstar]

I would always start at the hind leg when you see camping under its a huge indicator do things going wrong behind .
I might for cheapness start by blocking one front foot .
Often the horse gets worse behind when you do that then you know .
Horses get lots of pain in front compensating for soft tissue issues behind .

 

[ihatework]

This is the thing. I will always find the money for him, although now personal circumstances are challenging. But I wont do any surgical intervention or box rest with this horse. And he doesn’t need to be anything other than a happy field pet. So I don’t know how much to do. I know with my own health I spent thousands on private tests to be told nothing definitive, and yet I still definitely had problems. I’m just really confused as to what to do for the best for him.

Suspensories. Might be worth doing as reasonably easy to scan and block but in all honesty even if positive I would guess they are part of a bigger picture and what are you going to do about them? Shockwave with moderate success? You have already ruled out an operation.

That takes you back to a wider potential orthopaedic issue. I’d agree the neck could be worth considering.

I think I’d be inclined at this stage to bone scan, see what glows and strategically inject.

Is he responsive to bute?

 

[BBP]

I find the neck thing interesting. It could very well be a neck issue with this horse.

I've been hearing more and more about neck issues recently and it makes me wonder if they've always been there, but we've just starting paying attention. Or if they've just become more common. I don't know.

I just want to say, OP, that I really respect you trying to do your best for this horse.

Thank you. He’s my best mate and he’s had such a long history of issues (from being a lunatic to back and ride away, breaking me a lot, to sacroiliac, RER, hay fever, ulcers, snapped hind splint, cellulitis, all sorts) that I gave up a long time ago on thinking a horse was something you ride regularly. Now I take huge pleasure in just being around him. I have learned so so much about horses from him. I look back and wonder if I missed something key even as a 3 year old that has made him so predisposed to all this stuff. Makes you feel pretty guilty.

 

[BBP]

Suspensories. Might be worth doing as reasonably easy to scan and block but in all honesty even if positive I would guess they are part of a bigger picture and what are you going to do about them? Shockwave with moderate success? You have already ruled out an operation.

That takes you back to a wider potential orthopaedic issue. I’d agree the neck could be worth considering.

I think I’d be inclined at this stage to bone scan, see what glows and strategically inject.

Is he responsive to bute?

The two movement videos are him on day 7/8 of a danilon trial, two sachets a day which for his size is a fair bit. He seemed looser in some ways, but the restriction to the stride is still there.

 

[BBP]

The thing that caught my eye was his near hind and how low the fetlock went, the front end could be caused because of issues behind.

That’s a really good spot, I hadn’t noticed that before (will now spend rest of day comparing different horses hind fetlocks in the trot)

 

[sherry90]

Hind suspensories? Horse on my yard had PSD and presented lame in front (looked like shoulder) this was just secondary pain to the PSD.

 

[Polos Mum]

Not insured and assuming you don't win the lottery in the next few days and you're happy for him to be a field pet I'm going to suggest differently as an alternative option.

His feet can be improved (I think if I understand correctly), that is within your gift to do, cheap and should help all round. Get on top of any thrush, shorter trim cycles etc. etc. and see if there is any improvement, if not you can rule that out and you've not lost much (other than some field rest time for him - which is unlikely to make been detrimental to anything else).

I would go slowly focusing on things that I could change / fix first and work my way to bigger decisions.

Is your vet happy with his quality of life in the field / rest - if so you don't need to dig too hard too quickly.

IF you neck x ray or find horrible things in joints what is the treatment (if you've ruled out box rest and surgery) - field rest presumably? so what is the harm of starting there.

My 50p's worth (as an accountant not a vet!) is that it's multiple things all linked together that have been going on years and years - so sadly there is unlikely to be one magic fix injection that will make him right. Sorry I don't mean to be harsh - just factual, with these types the more you dig the more you find. Like peeling an onion - layer after layer of issues.

 

[sherry90]

Right fore looks more ‘stabby’ to me - if that makes sense!

 

[chaps89]

He reminds me a bit of my mare.
She went lame on her left fore, which again we couldn't really nerve block too extensively, other than to narrow it down to between fetlock and knee.
However she had always had issues behind too, never lame enough to pinpoint but always not quite right. She was always lacking oomph or push from behind yet she would track up well or even over track, but sometimes toe drag too and canter would be like pushing a wheelbarrow through thick mud, and she stands camped under too.
Vet managed to get enough of a nerve block in to the hind suspensories for us to see a noticeable difference - and because she was going better behind, the issue in front was much improved. We're also uninsured and so didn't spend a huge amount on diagnostics (relatively speaking)
She's since had the suspensories medicated and was like a new horse.
They didn't last long, and the left fore lameness returned as well as having no engine, so she's had it done again last week and that will be the last time so hoping we have a summer of fun.

Quite a bit of that resonates with that video and what you have said about BBP. But then I guess we all find things that we have our own experience of!
Frustrating when things are all connected and you have nowhere obvious to start.

Personally I'd be worried about him being a field ornament, just because the way he gets up worries me/gives me the heebiejeebies and I'd be worried about him getting stuck or his leg giving way as he got up one day :-/ but clearly I'm not a vet!

But it's obvious how much you love this pony and I do hope you can get to the bottom of it all one way or another