Severe lameness after IRAP?

S

suem

New User
Joined
10 September 2010
Messages
7
Visit site
Hi there,
This is my first post, so hope my forum etiquette is OK!

Would really welcome any thoughts on what to do about my 13 yo Section D who was diagnosed with coffin joint DJD a few weeks ago. Vet advised IRAP. First injection was fine, but after the second he was 9/10 lame within 24 hours. Now 2 weeks on and no improvement at all. He is on antibiotics (just in case), anti-inflammatory drugs and on box rest (which he hates!).
I think that the injection may have damaged his periosteum, but have no idea what to do to reduce his suffering. Vet can't tell me how long it will last.
Has anyone had similar experiences or any idea how long this severe lameness will last? I hate to see him in pain and am beginning to wonder whether I should let him go rather than see him in agony.
Thanks
Sue
 
Sounds like he should be in a good veterinary hospital RIGHT NOW! Joint may be infected from the injection, or as you say periosteum damage. Sorry, fingers crossed for him.
 
What has your vet said? I would be expecting far more veterinary intervention and help with such an adverse reaction/level of pain.

My horse had IRAP treatment earlier in the year and I remember being warned that such a reaction/extreme lameness is rare, but very bad news :( :(

ETS - Sorry, as Halfstep has said, such lameness after IRAP tends to indicate an infected joint, which with two weeks without treatment is, well, pretty dreadful for the horse :(

(My horse managed to go lame 24 hours after one of her jabs; one instant, very panicked and emotional vet visit later, it turned out to be the worst timed foot abscess ever!!)
 
Last edited:
Thanks for advice. Vet has been seeing him almost daily and is advising box rest and hot and cold tubbing. He is convinced that there is no infection.
 
I think I would be wanting more action and less thinking it is ok.
It is worrying to be that lame after 2 weeeks !
Without sounding rude could you ask for a second opinion .
Joint infection are REALLY bad news and need dealing with straight away
I know of one horse after a joint infection is now lost of use and unrideable.
I think I would be ushing harder for answers.
 
suem said:
Thanks for advice. Vet has been seeing him almost daily and is advising box rest and hot and cold tubbing. He is convinced that there is no infection.
Click to expand...

I'm sorry, but for a horse 9/10th lame, for whatever reason, I wouldn't be happy with that. Especially as lameness after an IRAP is such bad news (I know the vet who came to check my horse when she went lame after hers said that he did so with his heart in his mouth the whole drive there!!)

Is your vet an equine specialist? Could you get a second opinion?
 
as others have said really but maybe the reason your vet is saying he's sure there's no infection or anything wrong from the procedure is because he knows that if something did happen to be wrong it would be because of him (or possibly his fault).

i had the same happen with a dog, vet said it was nothing wrong with the procedure he had so shouldn't have complications etc, after not getting answers for over a week and watching my dog suffer i got a second opinion, turned out there had been a problem from the initial procedure so they had to operate.

not saying all vets or situations are like that but bear it in mind and get answers, if you aren't happy with the help then ask another vet to examine.
 
Good point about vet culpability - I do think that he is being very defensive, but at the same I also believe that he is doing all that he can and that the pain is not caused by infection.

I will get 2nd opinion if no change over the weekend.

My biggest question at the moment is how long this might last. If I knew that it was going to be a week or a month or longer I could deal with it more easily (I think!)

Thanks all for your kind thoughts and advice
 
I personally know of three horses that have been PTS following joint infections - I am another for horsepital ASAP!

good luck and keeping my fingers crossed
 
suem said:
Good point about vet culpability - I do think that he is being very defensive, but at the same I also believe that he is doing all that he can and that the pain is not caused by infection.

I will get 2nd opinion if no change over the weekend.

My biggest question at the moment is how long this might last. If I knew that it was going to be a week or a month or longer I could deal with it more easily (I think!)

Thanks all for your kind thoughts and advice
Click to expand...

That's a long time to leave a horse which is that lame. I assume it's on pain relief?
Nobody can answer how long the lameness will last as we don't know what's wrong! I can't imagine your horse will come magically sound overnight if it is 9/10ths lame, why on earth you would wait until after the weekend is beyond me.
 
if you think he is being defensive then get a second opinion. at the end of the day it's your horse that matters, if your vet gets narked over you asking someone elses advice then he is obviously hiding something (in my opinion and experience).
if the second vet says the same as the first vet then maybe you should push for more extensive treatment/diagnosis.

the longer you leave it the more expensive it will be, the more pain your horse will be in and the greater the risk of losing your horse. i don't mean to sound harsh to you or your vet, i don't know either of you BUT you do have to think of your horses wellbeing and push for a diagnosis. might be something simple and easy to fix but on the other hand it might be something worse.
 
I'm afraid that I would be very concerned about your horse. Severe lameness following intra-articular medication is always of great concern and should be investigated thoroughly and treated aggressively (if required). I would suspect either joint sepsis i.e bacterial infection or a "joint flare" i.e an aggressive immune response in the absence sepsis. Either way the likely treatment is arthroscopic removal of inflammatory contents and high volume flush under GA. Joint sepsis after joint injection is a recognized complication and need not imply negligence but to ignore it or to treat it inadequately may well be. You need referral to a hospital capable of accurately diagnosing the problem and operating promptly if required. It will not be cheap we tend to bill between £2700-3500 for a single surgery + aftercare but if you have a near NWB horse and an infected joint you have little option, sorry for the candor.
 
Mine had IRAP, started getting a bit more lame and vet took out some of the fluid from the joint to send off to double check no infection. In the end it actually turned out to be a torn DDFT.
Has your vet done this yet? This would give you an answer very quickly. As the others have said, I was warned about lameness shortly after the injection and how dangerous it could be. Phone another vet & ask them for advice/help.
 
My horse has had approx 20 inter joint injections including the IRAP and has hardly been lame at all. I would be seriously be worried if I were you and demanding further investigations.
 
You need to ask your vet to 'tap the joint' to check for infection, he will have to go to the clinic for that to be done, but it only takes a few minutes to check. My boy had IRAP and was lame, vet taped the joint (inserted needle to check fluid and see if there is infection) and he had a massive hematoma from previous injection that had gone wrong!!!!!don't ask! we were all covered in blood when it burst, but horsie was more comfortable after. I would go back to clinic it's being going on far too long. good luck.x
 
All,
Thanks for the good advice and concerns. You will be pleased to hear that he is much sounder now and improving daily. I did get a second opinion and this vet confirmed that there was no infection and the pain was caused by needle flare. Another 2 weeks box rest on bute and glucosamine with 5-10 mins in-hand walking each day.
Now just got to get my head around the longer term prognosis and whether to risk repetition with further IRAP treatments!
Sue
 
stranger1612 said:
I'm afraid that I would be very concerned about your horse. Severe lameness following intra-articular medication is always of great concern and should be investigated thoroughly and treated aggressively (if required). I would suspect either joint sepsis i.e bacterial infection or a "joint flare" i.e an aggressive immune response in the absence sepsis. Either way the likely treatment is arthroscopic removal of inflammatory contents and high volume flush under GA. Joint sepsis after joint injection is a recognized complication and need not imply negligence but to ignore it or to treat it inadequately may well be. You need referral to a hospital capable of accurately diagnosing the problem and operating promptly if required. It will not be cheap we tend to bill between £2700-3500 for a single surgery + aftercare but if you have a near NWB horse and an infected joint you have little option, sorry for the candor.
Click to expand...

Thats what we had with Jacob- severe lameness within 24 hrs of IRAP injection, rushed him to horsepital where the joint tap was clear of sepsis but they went ahead with an arthroscopy operation to "tidy up" the coffin joint area.(£1700 ish) Jacob was significantly sounder post op. Long term he went on to have an MRI scan which clearly showed the insertion of the arthroscope but didnt show any significant reason (mild enlargement of collateral ligament)as to why he is still unsound 2 years on..
 
Glad that Stranger1612 got there first...I would wholeheartedly agreed...that situation would certainly have my heart thumping.

I have had one case have a joint flare following a navicular bursa injection, I tapped it over and pver and in 24 hours was still so unhappy took it for a MRI and did surgery anyway. The cartilage was totally wrecked and sadly the horse was PTS anyway. Flare should not be underestimated in its own right I think.

Hope your horse continues to improve.

Imogen
 
Last edited:
These risks are why I opted not to go for intra-articular injections for my much loved TBxID and went down the conservative route of transitioning to barefoot, supportive diet and managing his workload and environment

Now I do 4-5 hours out on rough terrain, lots of canter and gallops and he's doing pretty well and his feet are astonishingly good - result. Would I have got the same result with the injections? I really don't know but was not prepared to take the risk.

I think vets are far too quick to rush into these things, discount the conservative approaches, and bill ridiculous amounts - and then shrug it off when it all goes wrong, after all they can always PTS if it's not working....

damn - there I go, I tried to go a whole week without being cynical...and now you've gone and made me fall off the wagon :D
 
Wow! I'm getting a little anxious having read these posts and I am so glad that your horse is improving, OP. My horse has had his first IRAP last tuesday and so far, no problems but he is on box rest for 2 weeks. This is the culmination (I hope!) of a long spell off work for my boy and continuous vet treatment for PSD and arthritis in same leg.

I've taken the view that, whilst under insurance, I want to throw everything at the problem but I understood it to be a very safe treatment outside of needle infection as the horse's own blood is used. I will be examining my chap every 2 hours now!!!! :eek: :eek:
 
I'm glad your horse is now improving. My boy had irap for desmitis of lateral collateral ligament in July and his next one in August following remedial farriery, box rest and MRI scan. Took a severe adverse reaction (flare) to his second treatment. Had follow up MRI and the problem is now much worse. After 6 weeks of box rest, 5-10 mins in hand walking a day and more reshoeing there was no improvement. The joint has been tapped twice but no infection. He was then given steroid injection into coffin joint and again sadly there is still no improvement. To go back to vet school on Wednesday but it now looks as if I have no choice but to put my gorgeous boy to sleep. Has anyone ever heard of a horse recovering from this kind of reaction??
 
You must log in or register to reply here.
Top