SI prognosis

[I don’t like mondays]

Hi
My horse is a tricky one (on the ground and physically). I need advice please

He had KS surgery early this year (bone shave and removal- several fused VB). Rehabbed well (6 days pw long lining, poles, walking in hand, lunging etc) then months later I noticed canter issues on the lunge (changing leg, not engaging inside hind, reluctance to canter). Took him in for a work up, vet said SI issues, scanned SI and he had mild to moderate osseous remodelling in SI joint and intertransverse joints (lumber and sacral). Was injected with steroids and more rehab. I asked at the work up if they could scan suspensories and xray hocks but vet was adamant it wasn’t those so didn’t scan/X-ray. More rehab (he’s tricky on the ground so this wasn’t fun). I didn’t notice an immediate improvement (still swapping legs in canter). Vet said he needs to get stronger and keep going and cantering more (my gut was saying “surely this is pain?!).

Anyway rehabbed his SI as instructed but only managed 3 days pw rehab/work because he’s borderline dangerous (on the ground, not under saddle) and I started feeling burnt after almost a year of rehab.

So, some days he’s fine, other days he still doesn’t want to canter. He also trips behind occasionally (hacking). Physio says he’s not engaging his hocks fully and has lost topline but to up his rehab work and build strength. A pro has ridden him for me (hacking) and says he feels weak behind so needs more strength. Had a few lessons and instructor thinks he looks fine.

Well done if you’ve got this far!!

I’ve got the vet coming Monday because I want her to do a work up. I need to decide if I want to keep going with my horse (his behaviour on the ground has got to a point where I need help but this is going to be expensive). Does it sound like the SI is too far gone? Should I ask for the suspensories and hocks to be checked? Does SI dysfunction this bad (bony changes) usually have a poor outcome?

He’s so opinionated and reactive on the ground I couldn’t have him as a pet or happy hacker so I might need to make a hard decision

Thoughts and opinions please guys
Thank you as always

 

[I don’t like mondays]

ETA my horse is often reluctant to bend left (not always but sometimes). Eg I lunged him for the physio and he was really pulling to the outside. Is not wanting to bend an SI thing?

 

[Birker2020]

Firstly I'd be guided by the pro rider, vet, physio and not the riding instructor who probably won't be in the know when it comes to this.

At this stage I'd want to get xrays of hocks and ultrasound of suspensories to see if these are problematic and also to guage any potential ongoing treatment costs as these are things that will need money throwing at them on a regular basis, i.e. yearly. How did the vet rule out hocks and suspensories without imaging?

You might have to bite the bullet and get all this diagnostic evidence, because you will have a clearer picture of the horses issues in their entirety and whether you wish to continue shelling out. And lets face it, unless you have oodles of money, most of us would be reluctant to continue doing that.

I've heard a great deal about SI issues recently with lots of people on the forum saying the outlook isn't good but I have also heard from one vet that actually the outlook is very good, and from another vet that he has prescribed it in the past and its usually a good outcome, and from friends who have said that there are horses going around Badminton that have had their SI's medicated at some point or other. So its not cut and dry, I suppose it depends on the horse and the cause of the SI pain and any contributing factors. I am not sure if hock arthritis and KS is just 'one of those things' or whether it predisposes a horse more to SI'. I expect it is the latter.

I wish you luck. I have sent you a PM (or will do at some stage today - work is very busy at the moment). x

 

[I don’t like mondays]

Firstly I'd be guided by the pro rider, vet, physio and not the riding instructor who probably won't be in the know when it comes to this.

At this stage I'd want to get xrays of hocks and ultrasound of suspensories to see if these are problematic and also to guage any potential ongoing treatment costs as these are things that will need money throwing at them on a regular basis, i.e. yearly. How did the vet rule out hocks and suspensories without imaging?

You might have to bite the bullet and get all this diagnostic evidence, because you will have a clearer picture of the horses issues in their entirety and whether you wish to continue shelling out. And lets face it, unless you have oodles of money, most of us would be reluctant to continue doing that.

I've heard a great deal about SI issues recently with lots of people on the forum saying the outlook isn't good but I have also heard from one vet that actually the outlook is very good, and from another vet that he has prescribed it in the past and its usually a good outcome, and from friends who have said that there are horses going around Badminton that have had their SI's medicated at some point or other. So its not cut and dry, I suppose it depends on the horse and the cause of the SI pain and any contributing factors. I am not sure if hock arthritis and KS is just 'one of those things' or whether it predisposes a horse more to SI'. I expect it is the latter.

I wish you luck. I have sent you a PM (or will do at some stage today - work is very busy at the moment). x

Thanks so much Birker. I was confused as to how the vet could rule hocks and PSD without imaging too, I subsequently asked her again and she said it no it’s not that. I’ve got a different vet coming Monday with a fresh pair of eyes. At this stage (coupled with his on the ground behaviour) I’ll need to decide if I want to keep throwing money at him

 

[nutjob]

I have rehabbed one with a SI problem successfully but he doesn't have KS. However, I also know a couple of people whose horses have had KS surgery, appear to be rehabbed and then have later turned out to have a trio of SI/hocks/suspensories. I don't have any experience with hock issues, but it's not too expensive to have an ultrasound of the suspensories and if it was my horse I would want to know one way or another as I've had a very poor outcomes with PSD.

 

[I don’t like mondays]

I lunged my horse today and it was the worst he’s been so far :-( I’ve got the vet out on Monday but I’m wondering if I should ask for more things to be checked or call it a day (depending on what the vet suggests). I’m self funding and have spent thousands on him already (KS surgery, SI injections). Today’s symptoms were:
1) happy in walk (not fresh), exploding and leaping, rearing when asked to trot for the first time
2) hopping into trot (so front end comes up instead of pushing from behind- he’s always done a bit of this, today was bad)
3) Reluctance to canter
4) changing leg in canter
5) disunited in canter
6) exploding serveral more times with upward transitions (40% of transitions). Not calming at all (as a fresh horse would). Cantering off in a blind panic, coming in towards me on a tight circle and motor biking, leaping (bucking, rearing too close to me for comfort)
7) tripping over trot poles
8) short and choppy in front in trot- shoulder looking really stiff

Does this sound like PSD or hocks? Or an SI issue that can’t be fixed? If all of this could be, say, hocks and that could be injected I’d be so happy. I’m wondering if I should ask for X-rays and suspensories to be scanned or whether this is too far gone. I felt like I was going to end up in hospital a few times today :-(
Thanks

 

[nutjob]

My horse whose SI has I believe been successfully rehabbed is young and had an accident, yours sound more like some sort of progressive degeneration/underlying issues where typically the outcomes seem to be worse.

I had one with PSD which was PTS at age 6 as he couldn't even be comfortably retired. As well as both hind legs which had disintegrating suspensories he became intermittently lame on a front leg probably due to abnormal gait at the back and extra strain elsewhere. Similar to your point no. 8.

The behaviour you describe sounds more like the PSD, mine was investigated initially due to his change in behaviour. Two trainers thought this one was sound and his sharp spooky behaviour was a result of me become nervous when I was riding (it was the other way round, I became nervous due to his unpredictable extreme behaviour).

If you don't know the extent of the problems then you may not be on the right rehab strategy, lunging would not be something for a horse with suspensory problems nor the extensive pole work which helped my SI horse. For not much money your vet might be able to get a clue as to other issues by flexion testing. Hocks could give a positive and my PSD horse couldn't be flexion tested as the flexion itself was too painful.

If you have ruled out retiring the horse then it's up to you to do to decide how much more money time/effort to put in. I would probably have hind suspensories scanned as this is not expensive and if PSD was found my decision would be easy and I would PTS. Just as valid to call it a day at this point when it looks like there are multiple problems which haven't resolved after a year of rehab work. I'm very sorry, I really feel for you as it's so difficult when there is not a clear way forward and you have invested so much already.

 

[I don’t like mondays]

My horse whose SI has I believe been successfully rehabbed is young and had an accident, yours sound more like some sort of progressive degeneration/underlying issues where typically the outcomes seem to be worse.

I had one with PSD which was PTS at age 6 as he couldn't even be comfortably retired. As well as both hind legs which had disintegrating suspensories he became intermittently lame on a front leg probably due to abnormal gait at the back and extra strain elsewhere. Similar to your point no. 8.

The behaviour you describe sounds more like the PSD, mine was investigated initially due to his change in behaviour. Two trainers thought this one was sound and his sharp spooky behaviour was a result of me become nervous when I was riding (it was the other way round, I became nervous due to his unpredictable extreme behaviour).

If you don't know the extent of the problems then you may not be on the right rehab strategy, lunging would not be something for a horse with suspensory problems nor the extensive pole work which helped my SI horse. For not much money your vet might be able to get a clue as to other issues by flexion testing. Hocks could give a positive and my PSD horse couldn't be flexion tested as the flexion itself was too painful.

If you have ruled out retiring the horse then it's up to you to do to decide how much more money time/effort to put in. I would probably have hind suspensories scanned as this is not expensive and if PSD was found my decision would be easy and I would PTS. Just as valid to call it a day at this point when it looks like there are multiple problems which haven't resolved after a year of rehab work. I'm very sorry, I really feel for you as it's so difficult when there is not a clear way forward and you have invested so much already.

Thanks Nutjob. Yes, I too have been told it’s my nerves however I wasn’t nervous until I had to deal with extreme behaviour for a sustained period of time. In the work up, my horse was sound and flexion test was ok, can it still be suspensories do you think? Looks of the behaviour points to suspensories doesn’t it (and PSD/SI/hocks/KS seem to go hand in hand)

 

[nutjob]

So I think you have to work through what your options are, these are the ones I can think of:
1. PTS straight away, not a wrong decision at this point, irrespective of whoever says the horse is sound there is still a problem somewhere.
2. Spend money on further investigations, the definitive for suspensories would be an ultrasound. Mine couldn't be flexioned due to pain but he was in a bad way already, if there was less damage I don't know. The problem is if the suspensories come back clear you then have to decide whether to chuck more money at it and xray hocks. You may end up back at 1 anyway but with less money.
3. Continue to try to rehab - I wouldn't, horse not safe, current protocol may not be helping and definitely struggling for some reason
4. Turn away for 1/2 months, see if the horse gets better or worse and give yourself a break and time to think things through and come to terms with the situation.
5. Ask the vet if another steriod injection to the SI would help. Bear in mind that often horses with only SI issues cannot be rehabbed back to ridden.

I would do 4, and see how the horse is in himself, if miserable, stressed and/or dangerous then back to no.1 but I would keep a retired horse so my situation is different.

If the suspensories are very bad the fetlocks drop when they walk sometimes it's kind of in 2 stages. I would expect a vet to see this but you could do a slo mo video yourself.

 

[greenbean10]

Thanks Nutjob. Yes, I too have been told it’s my nerves however I wasn’t nervous until I had to deal with extreme behaviour for a sustained period of time. In the work up, my horse was sound and flexion test was ok, can it still be suspensories do you think? Looks of the behaviour points to suspensories doesn’t it (and PSD/SI/hocks/KS seem to go hand in hand)

My horse looked sound, passed flexion tests and had PSD.

I wouldn’t scan the suspensories, I’d ask the vet to block them instead. IMO this is more definitive as scans may not look too bad, or suspensories may not be the whole issue. Even a slight improvement would point to suspensories being part of the problem.

Plenty of horses have had SI issues and come back really well. Almost every showjumper at my yard has had its SI medicated at least once! If the horse is good under saddle could you ride him instead of working on the ground? How does he feel hacking out - just weak?

I wouldn’t lose hope but I’d get the suspensories blocked.

 

[ester]

Ditto for blocking, he might well demonstrate he's not sound with one blocked.

 

[I don’t like mondays]

My horse looked sound, passed flexion tests and had PSD.

I wouldn’t scan the suspensories, I’d ask the vet to block them instead. IMO this is more definitive as scans may not look too bad, or suspensories may not be the whole issue. Even a slight improvement would point to suspensories being part of the problem.

Plenty of horses have had SI issues and come back really well. Almost every showjumper at my yard has had its SI medicated at least once! If the horse is good under saddle could you ride him instead of working on the ground? How does he feel hacking out - just weak?

I wouldn’t lose hope but I’d get the suspensories blocked.

Thanks Greenbean. Can they do nerve blocks at the yard do you know? One of my horses issues is that he now panics (becoming dangerous) when closed into a trailer for travelling so would need IV sedation just to travel :-( With his last work up they wouldn’t block “due to vet safety” (because it’s the kicking zone and he’s been a handful before when in hospital). Also the symptoms seem to come and go- last week his canter looked ok on the lunge whereas yesterday it was awful. Would this mean it was hard to see if nerve blocking would work? He’s good under saddle but trips behind. He’s also got separation anxiety so is reluctant to leave horses to go into the arena

 

[greenbean10]

Thanks Greenbean. Can they do nerve blocks at the yard do you know? One of my horses issues is that he now panics (becoming dangerous) when closed into a trailer for travelling so would need IV sedation just to travel :-( With his last work up they wouldn’t block “due to vet safety” (because it’s the kicking zone and he’s been a handful before when in hospital). Also the symptoms seem to come and go- last week his canter looked ok on the lunge whereas yesterday it was awful. Would this mean it was hard to see if nerve blocking would work? He’s good under saddle but trips behind. He’s also got separation anxiety so is reluctant to leave horses to go into the arena

Yes, they can do nerve blocks at your yard, in fact it's probably better as it means the horse won't be agitated and act differently from being in a new environment.

Blocking suspensories can be very painful for them. We had to sedate mine to block the suspensories because he also tried to kick the vet. We sedated, blocked, waited for sedation to wear off and then rode. The blocks last longer than the sedation so it wasn't a problem.

As Ester said, the horse could be bilaterally lame behind so look sound. Blocking just one suspensory could make the horse noticeably lame (as then they are theoretically only lame on one leg), in which case you would have some sort of an answer even if it's on a day where the canter is okay.

Tripping behind could definitely just be weakness. If he is okay and happy other than that then I'd also be tempted to follow the vet / physios advice and do lots of strengthening work with him (under saddle if it's safer). Perhaps you could give yourself a few months as a timeline and see if he improves?

 

[Bellaboo18]

Sorry if you've mentioned this and I've missed it but has he been scoped for ulcers? They normally result in explosive behaviour...

 

[sbloom]

I am not sure if hock arthritis and KS is just 'one of those things' or whether it predisposes a horse more to SI'. I expect it is the latter.

However, I also know a couple of people whose horses have had KS surgery, appear to be rehabbed and then have later turned out to have a trio of SI/hocks/suspensories.

I am "only" a saddle fitter but the people I respect the most (holistic vet, bodyworkers, rehab professionals) will all say that these issues are linked, and are all linked to posture. Hocks, suspensories, SI and KS. I can't comment on something like a prognosis or your particular case, and would never want to, but without really good postural rehab (and an awful lot of rehab really doesn't focus on posture) I think it would be very difficult to fix this whole pattern unless, as others have said, the first injury really is an injury, and not the result of a final tweak breaking something that has been massively compromised through repetitive strain.