Pastern Joint - UPDATE

[Jomanser]

Update on my previous posts - pastern joints and MRi Scans!

Had quite a stressful week last week. Horsey started to feel unlevel again on Wednesday. We thought maybe it was just him being tight and skitty, as it was a howling wind and he gets very uptight when its windy. But still unlevel on Thursday. Only ever so slightly on the right rein, but enough for me to feel it and mum to see it from the ground. So had lengthy conversation with vet who said the next course of treatment would be an MRI to ascertain excatly whats going on. So phoned insurers to check they would pay for it, and I only have a £1000 diagnostic budget. £200 of which has already been spent on x-rays & nerve blocks. In the mean time vet phone a specialist at Newbury. They said that an MRI wouldnt tell them anything they didnt know as the nerve blocks/x-rays are so accurate for this injury. It is also very rare to get this injury in the pastern! They said the next option was surgery - fuse the 2 bones together, 4 weeks tied up in a cast, then 4 weeks in a Robert Jones and then god knows how much box rest. I said there was no way I am prepared to put him through that:-
A) general anaesthetic is too risky on a horse his size. (17hh RID)
B) he is 19 and dont want to put him through all that trauma
C) no guarantee it will work as very tricky surgery
D) prob havent got enough left on my insurance to pay for it.

So only other option open to me is to bute him to try and get him sound. If he goes sound then great I can continue as normal and just keep a close eye on him. If the bute doesnt work then we are looking at him retiring/happy hacker. So not great news, if I had endless funds I would send him for an MRI just to confirm his condition, but they seem very certain it wont change anything and will only confirm what they already know.

I know I have to take the vets word for it, but in the back of my mind Im thinking 'what if its not what they think', but cant afford the MRI and sounds like its not going to tell me anything I dont already know.

So he now on bute and vet coming to re-assess him next week. Im really hoping the bute works. Fingers crossed.

 

[Wishful]

High field MRI also needs GA - you have to be very still. Low field MRI can work sedated but is limited and misses stuff (slice thickness issues) Also need to avoid sway from sedation. I've had 2 MRI scans. Both have missed cartilage damages that has needed arthroscopic repair - joy.

OH knows a fair amount - he did a research project on the diagnostic value of MRI and the equine carpus - was useful for me - he could ask the consultant intelligent questions about my wrist and the effectiveness of MRI and such like.

 

[Jomanser]

Ahh thats interesting. I thought MRI's pick up everything. Apparently he would be heavily sedated as being a big lad (and slightly portly) the GA is too much of a risk.
I feel confident it is what the vet says it is, but in the back of mind thinking would an MRI confirm it 100%. From what your saying - possibly not!

 

[Wishful]

Sadly surgeons (and vets) sometimes think that MRI shows everything. I had a small tear in my medial meniscus (knee) that didn't show on MRI so had 6 months of physio before the consultant decided that an arthroscopy was the way forward. Then, after damaging my wrist, again had a clear MRI, which missed cartilage and ligament damage dealt with arthroscopically (on saturday!), after 4 months physio and a very painful cortisone injection.

The problem is that cartilage is very small, and the "slices" of image are about 1-2mm thick depending on the protocol. Also, in more complex areas (e.g. wrists, equine knees), overlying structures can interfere with signals.

Possibly there is over-reliance on MRI saying that there is no problem when clinically there are symptoms.