Stifle issues - experiences of management please!

Orchardbeck

Orchardbeck

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Hi, I suspect my mare has undergoing arthritic changes to her stifles and has been for some time, I had a vet out to see her as I was worried she had some sort of pelvic/hock issue but he wasn't convinced, plus she showed no discomfort to a hock flexion test. however subsequently the Physio pointed at the stifle area as being the potential culprit.

The vet gave me danilon to try daily to see if that helped but it made no difference- she still showed stiffness in her hind legs - it looks as though she struggles completing the movement with her fetlock, but it is coming from higher up. She is on joint supplements.

It's difficult to tell whether she is in pain - she has been cantering around the field more than usual lately - or whether it is a kind of mechanical lameness - she seems better living out.

I would be looking to bring her back in to work as I have had my baby ( she hasn't had any work for 4 months) but only if she can tolerate it. She is weak behind and always had been as she has never been properly schooled. She is older too - 23 - but seems younger in all othe ways other than this.

She has slightly cow hock conformation - I guess these things jump up and bite you on the bum later on!

The vet's coming out to reassess but I wonder if anyone had any advice in this type of issue, and how they addressed it - or did they become field ornaments...?!!
 
I had some success with IRAP but it depends (obviously) on what the issue is and how much investigation you want to do with an older horse. Mine had arthroscopy to diagnose as x-rays and scans weren't useful (it presented like a meniscal tear but was actually OCD). Steroid injection did nothing. IRAP worked out at under £600 although they wouldn't inject a stifle in the yard so he had to go to hospital as an outpatient 3 times (once overnight). IRAP, rehab and turnout got him sound enough for a light hack.
 
Motherofchickens - thanks, that's really helpful. Haven't come across IRAP as a treatment so will do my research! That's exactly it - she is an older horse, not a competition animal, so I wouldn't want to put her through loads of investigative sessions if we can help it - I don't want to go down the injection route with her really.

I guess I'll just have to see what the vet comes up with, but they aren't equine specialists, more cattle so I feel I have to be more on the ball with things or they fob me off that everything is ok.
 
When you say she's weak behind, what do you mean please?

What vits/mins or balancer is she on? Does she receive the full daily ration?

Sarah
 
Hi there, my cob has 2 slipped stifles...Is this what your horse has?...vet said lots more exercise, and trotting up hills..good luck with your equine.x
 
flintfootfolly - when I say she is weak behind, I should have said she seems to be under developed muscle wise in her back end, from a history of pulling herself along from the front end - her shoulders are a lot bigger than her back end.

She has been on topspec Antilam with added mag ox, Topspec 10:10 joint supplement and I recently added agnus castus as she is hormonal and a possible Ems candidate. She has been receiving the recommended amount (400g) for her size.

I have however just today moved her on to the Forageplus Hoof Health winter balancer, with a handful of speedibeet, the agnus castus and 10:10 plus an addition 100g micronised linseed as advised by Forageplus. She is a good doer normally so I'm going to have to keep an eye on the linseed causing weight gain.

She is out 24/7 at the min, in a small short paddock during the day (unmuzzled) and in a bigger paddock at night with a muzzle on.

Gillrossini - I'm not sure, it is
 
Sorry, possible. She seems better walking around on it, but there is definitely something going on - I saw her stretching her off hind out behind her a few days ago as if something was stuck, which is not normal for her, and when the farrier came to trim her up she put up
 
Thanks for the details.

I can only give one angle on this, and of course there's no guarantee this is what's happening, but it's just one thing to consider alongside everything else.

Locking stifles or intermittently locking stifles can occur because of weakness of the associated muscles. Weakness of the muscles can occur because of underlying muscle disease, which can be genetic or dietary (my reference for this is the Beth Valentine chapter on mechanical lameness in the Ross Dyson lameness book, which is the main veterinary reference book for equine lamenesses). One of the dietary causes of muscle disease is selenium deficiency. This is what I believe my gang have, and I've spent the last year and a half trying to prove that.

Whilst only one of mine showed intermittent stifle problems, the two worst affected show a stiff hind limb action. The hind legs never move through as actively as the front legs, so it was this too that sounded similar to yours. One of mine had very overdeveloped front top-of-leg muscles, presumably from pulling herself along.

Especially because yours is a good doer on a restricted diet, it sounds like an increasing possibility to me. One nutritionist said to me she was seeing a lot more good doers who were "overfed but undernourished" - in other words they are getting too many calories so are putting on xs weight, but are not receiving enough minerals so are undernourished in that respect. I managed to get the weights of my gang down significantly (over 100kg each) about 3 years ago, mainly by diet restriction, but I made the mistake of not giving vits/mins and I think that is one of the things which precipitated what I am seeing now.

Whilst I don't use Forageplus myself, it does contain organic selenium (selenium yeast) which is the only type of selenium which appears to have brought about an improvement in the muscle health of my gang (measured by measuring the level of creatine kinase, CK, the main muscle enzyme, via routine blood tests), whereas 10 months on a balancer with inorganic selenium (sodium selenite) did not result in an improvement in those levels.

So I'd think it was a good move that you've switched to a balancer with organic selenium.

If you wanted to test this idea a bit more, you could always ask the vet to do a blood test for the 3 main muscle enzymes CK, AST and LDH, or even just for CK (at that is totally muscle specific). If you go that route, insist on a copy of the full blood report as many vets don't recognise the importance of even mildly raised muscle enzymes. But anything over 350u/l is used as being indicative of muscle disease, by top equine muscle vets such as Stephanie Valberg and Beth Valentine.

If it is that, then I've found improvements to happen 4 to 5 months after starting on the organic selenium.

A simple mineral analysis on your grass/hay would show whether you have levels of selenium which are associated with a deficiency and potential muscle problems. I use Sciantec in Cawood, Selby for forage analyses, but there are plenty of places who offer them. Selenium of below 0.1mg/kg dry matter is deficient. Mine came in at around 0.04-0.05mg/kg DM so were only providing 40-50% of NRC's recommended minimum daily intake. So for me, I now realise the importance of giving a good quality vit/min supplement or balancer daily..... and for me, "good quality" means organic selenium (selenium yeast).

Hope you get to the bottom of things.

Sarah
 
Wow, thanks Sarah, it does sound as though you have had a similar experience, that information is very useful. She had a blood count done a while ago but it doesn't mention the muscle enzymes so have nothing to go on there.

Selenium could be a contender- when I think back, a neighbour had a horse that they fed selenivite e to as it had problems related to a selenium deficiency - the vet had recommended this as there apparently a deficiency in the soil around here - i don't know why i didn't think of that before.

I plan to get the forage at least tested anyway, but having just spent out on the forageplus balancer, and with the vet and dentristry bill to come it will have to wait for another month!

The vet is coming out on wed to sedate her for dentistry work so I plan to get them to look at her again beforehand, but my guess is that you could be right, and it is muscular rather than joint related, therefore exercise, turnout and Physio may be the answer, so it will be interesting to find out. It's going to take a little while though, going from your experience!

Thank you very much!
 
based on under developed muscle in her back end and her age ie 23. Have you had her tested for cushings ie ACTH test?
Cushings affected the muscles very badly in my lad.

If the vet is coming on Wed have you considered an ACTH test when he is there? It is one blood pull that is sent off usually to Liphook if you are in England. It comes back with a number. You would have an answer within a couple of days.

In view of her age it would be something I would try as it is very simple to do.

If you decide to do it do it first thing when the vet arrives before any sedation and even before the vet or dentist does anything to make sure she is as little stressed as possible before testing.
 
It's very interesting to me that your mare may have metabolic issues as my mare has had a very bad locking stifle since the spring and she also has cushings which along with the fact she is retired has resulted in very poor muscle tone. I have had her stifle injected 2 weeks ago with steroid and so far the difference is dramatic. It is locking much less and I have increased her exercise so she is now doing 20 mins a day walking on the lunge and using poles to try and encourage muscle development.
 
Paddy555, thanks - I have been putting off the cushings blood test as I have an ethical dilemma about what to do treatment wise should Prascend be recommended - the expense is a worry. I have been feeding Vetex Agnus Castus as a substitute just in case, but I have decided to bit the bullet and get her tested tomorrow.

I discussed the selenium issue with the vet and he seemed a bit dismissive, in that it is only younger, growing animals that tend to suffer from a deficiency, and also that they have no idea of what the correct levels should be for horses when they do for sheep, cattle and pigs, for example. I however am not dismissing the idea, and the supplement will hopefully address this if it is an issue.

IornaA - that is interesting that you went down the injection route with an older animal, especially as it appears to have worked or helped at least.

I'll update the thread with the vet's opinion.
 
It doesn't surprise me the vet was dismissive of the idea of selenium deficiency.

The easiest things to to to try and rule that out are:
- provide a good supplement with organic selenium (by the way, I've just checked and selenavite only contains inorganic selenium, so personally I would look for a different one - in other words, one which contains organic selenium, ie selenium yeast)
- forage analysis (or even just testing the forage for selenium, which might keep the price down a bit more)
- blood test the muscle enzymes

I haven't found blood tests for selenium to be useful at all (nor blood tests for glutathione peroxidase (aka GSHpx)). It's the forage analysis and muscle enzymes which have proved the most useful.

Whatever is the cause in your case, I hope you are able to get to the bottom of it.

Sarah
 
FFF/Sarah - no I totally agree. I mentioned the possibility of selenium being an issue with my husband who is a farmer (arable and pedigree cattle) and straight away he said that this area is known to be low in selenium and he thought it very possible that it would need supplementation. thankfully the Forageplus balancer as you say has the organic selenium so we may see an improvement anyway.

The neighbour's horse that was was on Selenivite was sold some time ago so I don't know the outcome there. We (my mare and I) moved to my husband's farm/village 6 years ago which is a scary length of time if be has been deficient.

The other thing I can think of is I have been supplementing her with Mag Ox for her feet ( she is barefoot) and although most people would argue that any extra magnesium is just excreted without issue, I have also heard that an imbalance can cause an inhibition in the uptake of calcium - I have not been supplementing calcium until now other than what was in the Topspec Antilam balancer. I will no longer be adding mag ox as it is included in the Forageplus balancer.

I wonder If a calcium shortfall would also be significant here?
 
I'm sorry, I don't know enough about calcium and magnesium to comment on those, but my personal choice is to stick to a balancer rather than risk mixing things myself and getting it wrong (although a lot of people prefer to mix their own and say they've seen improvements).

The NRC's black book on feeding horses - Nutrient Requirements of Horses (NRC is kind of the american equivalent of DEFRA) recommends 1mg a day selenium as the minimum for a 500kg horse, so this equates to 0.1mg/kg dry matter in grass/hay etc (this assumes a horse eating 2% of its own body weight each day). NRC base their recommendations on available published research, and I do think their recommendations are the closest we can get to what really IS required, but there's still a lot that isn't known about minerals and their possible interactions with each other. Organic selenium is the form in which selenium occurs in plants, so that is what horses would be eating in their natural diet.

Interesting about your area being known to be low selenium. Sounds good that you are on the new balancer, whether or not selenium turns out to be the cause.

Sarah
 
So, had my intensive vet/dentist session this morning - vet feels my mare actually moves very well for her age (today she wasn't displaying the 'jerky'/restricted movement that she sometimes shows in her hindleg admittedly, but I can feel it when I ride her) and that she doesn't seem to have any hind end arthritis issues - in fact her joints are actually very flexible with no clicking or stiffness - for a 23yo, backed up by the opinion of the EDT who is an ex pro eventer.

However he did seem concerned that her sacroiliac joint seemed to be prominent even though she is fairly well covered and thought this may be the seat of the problem - the muscles either side are tight and could be the reason why she is resting a leg/stiff/slightly lame.

Vet thought a session or two with the physio would help, but it is possible that it has been a long term thing and may be difficult to sort.

The EDT showed me a stretching technique which involved picking up the tail so she would lean against me - even doing this under sedation we could see muscles twitching on the off hind, just beneath the SI area (Bicep something I think- need to look it up).

Other good news - vet doesn't think she is a Cushings candidate (second vet who has said this) and wasn't keen to do the blood test as reckoned 65% of older horses come back as having high levels anyway, even if they don't appear to be suffering. He felt she didn't have enough of the physical symptoms to worry about it, and looked well in herself, particularly condition wise, so I guess I'll continue with the Vetex Agnus Castus as it is obviously doing some good and is reasonably cost effective compared to the Prascend.

So, this week we have had the diastema in her teeth sorted, a general look over from the vet, tetanus jab done and her feet trimmed up; feed rejigged to include better minerals but keep up the Agnus Castus. I can probably get away with swapping the joint supplement Top Spec 10:10 for Vetvits Equiflex or something more reasonably priced, and I can cut out the Mag Ox as she now has the right amount in the balancer. Have to keep an eye on her condition though to make sure she doesn't put on any more weight as she is just right.

Just need a physio treatment and saddle rechecked and we're good to go... until next time! Phew!
 
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