stifle problem injection or arthroscopy

[Aeia]

Hi I'm new here but do read the forums from time to time!

I have a 5 year old gelding Neo who was rescued as a foal. No idea of his breeding but we think he's mostly standardbred. He was backed last year and has been a happy hack since, but always been rather unbalanced in trot!

For a while now he's not been tracking up properly on his right hind. It looked quite slight and I only really notice it on the lunge on the left rein. He's always been weak behing though from a foal to now. Even though we've done quite a bit of hill work this summer he's still not muscled up much (but he did come out of last winter pretty poor).

Had the physio out about 6 weeks ago and she said he was stiff on that side and did various massages etc and gave me exercises to do. About 3 weeks ago he was terrible going down hill on a road we hack on. Was taking very short steps and seemed to be dropping on his left shoulder (but I think the problem was now hitching his right behind). Thought he could be footsore at first (as ground was like concrete then and he's unshod) so rested him but he was no better.

Had vet out as he was due a vaccination anyway and she said he definitley wasn't right so I booked him in for a lameness exam.

When they lunged him on the hard ground on the left rein he was dragging his right toe and not tracking up on this side. Wasn't so bad on the right rein or in a straight line.

X rayed his stifle, showed nothing. So started nerve blocks from the bottom up. Nothing for foot, fetlock, hock then when they blocked the whole stifle he didn't become sound but was noticeably better. Did ultrasound of his stifle which showed nothing. Another vet had a look and thought he looked like he had a slight neurological defecit but did the various tests and the only one he didn't do was move his back hoof off the other hoof when you put it there, but that's not conclusive.

He's not hopping lame and is happy out in the field so I don't think he's in a lot of pain. Vet has given me 2 options.

1. Steroid injections into the stifle and see if he improves with an exercise programme. But in this case we'd not know what was wrong and it could just mask the problem.

2. Arthroscopy to see if they can find out what is wrong and if they do maybe treat it. This would require long box rest and then slow rehab.

I'm unsure what to do. We're pretty sure whatever it is has been going on for a while as there's muscle imbalance. As he's only 5 I was wondering if it could be OCD but there's no sign of it on X ray or ultrasound.

My thoughts are go for the injection now and see how he goes for the rest of the summer. If this doesn't help go for the arthroscopy. I don't think he'd enjoy box rest now as all the horses on the yard are out 24/7 and he loves to be out. At least if he's boxed rested in the winter others will be in as well. My only slight worry is that in the mean time more damage could be occuring as the steroid may just mask the problem.

Anyone had experience of this? What's frustrating is not having a diagnosis..

 

[minmax]

My 4 yr old went for arthroscopy for OCD, it showed a little on the xrays but was very bad when they went in for a look. The cartilage is damaged which didn't show on xrays. If you want to go the injection route you may be causing more damage working him that may be treatable now? If the horse is insured maybe go the op route, as you may find out its only slight and can be treated otherwise you will always wonder. Good luck either way

 

[Bubbles]

I was in the same boat as you about 18 months ago, I opted for the surgery which turned up cartilage damage in one stifle. I was going to treat with steroids and just see what would happen, but decided I had to know hence surgery, which in my horse's case turned out to be the right call. From memory the rehab wasn't that bad, 2 weeks solid box rest, 2 walking in hand twice a day then field rest for 8 weeks: I put him out full time in a small ish paddock. One thing that would put me off using the steroid jab is that you really only want to be using that once you know what you're dealing with. Good luck, I hope you get him sorted.

 

[Aeia]

I'm going to have a chat with the vet when she's next in on Tuesday. She did say that having the injection wouldn't proclude having surgery later on. But like Bubbles the not knowing is the worrying thing.. I also need to work out costs as the insurance company will class the arthroscopy as a diagnostic investigation as we still don't know whats wrong so my limits are much lower.. annoying!!

 

[star]

my horse has a stifle prob diagnosed by bone scan in Apr after being v slightly lame for a month despite rest. cant nerve block him as he'd kick the **** out of you. xrays didn't show much. bone scan showed a hot spot. he had arthroscopy which showed bilateral OCD and inflammation of the cruciate ligament. he's had 8wks box rest and is now on 6mths paddock rest. if I'd gone for steroids i wouldn't have known what was going on in the joint and could have made things worse.

 

[Aeia]

I can imagine rear limb nerve blocks are challenging on some horses! Neo was so good, only kicked up a couple of times I think he just thought is was a big nasty fly. They did sedate him for the stifle block though as it was 3 needles.

Going to have a chat with the vet on Tuesday. He's been happy on paddock rest the last few weeks. I did trot him up today and popped him on the lunge in the school and he looked better than last week when I lunged him the night before we went to the vets. But was still not quite right on the left rein. Its hard to tell though as the toe dragging is much more evident on the hard ground and I haven't got anywhere at the yard I can lunge on a hard surface.

My main worry is OCD. But another thought is possibly a growth spurt and some growing pains. Even though he's 5 he's filled out more this summer than last and although I haven't been able to measure him accurately he may have put on a couple of inches in height! He's not looking as bum high as he did.

It could be OCD though as he was lame on his fore last year, came sound with small paddock rest so I'm wondering if its the work that flares it up. Then again he's been sound on his front this summer and we've been doing much longer and much hillier hacks than last year.

Andrea

 

[Aeia]

Had a chat with the vet today and decided to go with the steroid injection. The main disadvantage of this is I wont get a diagnosis and there's a slight risk that more harm could be happening. She doesn't think this is too much of a risk. She only graded his lameness as 2/10ths lame so if there was lots of damage he would probably be worse.

Another reason for going this way is that my insurance will only pay up to £1500 for diagnostics (AM Trust). The last exam has cost £800 for the day spent getting nerve blocks, xrays and ultrasound. An arthroscopy would cost in the region of £2000 taking me well over the limit I'll pay it if I need to but would rather see if an injection works first.

Also as I've said before the arthroscopy would mean lots of box rest. 2 weeks complete rest and then 8 weeks being allowed out in hand! He'd go mad!

So the injection is booked for Friday afternoon. He'll then have 2 days box rest followed by 10 days paddock rest then gentle work. She said to avoid steep hills which limits my hacking as most of our best routes are straight up a steep hill! I'll have to hack around the bottom paddock and maybe see if I can get some others to come on some hacks round the local villages.

I haven't ridden him since he went lame (about 4 weeks), but going to take him round one of the big fields at the yard before Friday so I can assess how he is now so I can compare how he goes after the injection.. I did pop him on the lunge on Sunday and he seemed better then just after all the rest but she did say that a stifle problem can change from day to day.

Andrea

 

[star]

mine was only 1/10 lame - still plenty of damage going on in his joint. Another horse at my yard been lame for the last 3mths - finally just had arthroscopy to diagnose and has cartilage damage plus a torn cruciate ligament - never more than 2/10 lame.

I'm not trying to push you one way or the other, just thought I'd add that not very lame doesn't necessarily mean not much damage.

i think my arthroscopy was about £1500. Total bill was £3200 for a week in hospital, initial exam, xrays, bone scan and arthroscopy.

 

[Aeia]

I'm not ruling out the arthroscopy, main reason is I don't think he'd be happy in at this time of year. We don't compete so will only be doing gentle hacking and I'd stop that if the vet thought I needed to.

She said before they did the arthroscopy they'd probably want to do another nerve block just to confirm it was def the stifle. He did appear better with the nerve block, just not a great improvement.

Ultrasound and x ray showed nothing and I know they can't see the ligaments this way and can only see some of the joint as its so big but she said she'd expect to see something if there was a lot of damage doing on.

I hope your horse makes a full recovery after his rest.

Andrea

 

[cobwithattitude]

Horse had arthroscopy in Feb. Just began trotting mid July and horse 1/10 lame again - cortisone injection last week, 48hrs box rest and 1 week small paddock, beofre 3 weeks walking AGAIN!! But am glad have gone down this route rather than injection - injury to joint had damaged cartilage too. Have I spelt that correctly?! Long haul to fuill soundness and i have followed vet's instruction to the letter. Am not thinking about competing at mo; just getting a sound horse! Good luck.

 

[Aeia]

So far so good..

Well he had the steroid injection on the 6th August. A week off 2 days box rest and the rest paddock rest. I rode him gently a few times then had a nasty fall off him on the 15th Aug (stirrup stap came off so not his problem!). Had concussion and have also been ill so not ridden him much since.

Had the physio back to see him on the 24th and she said he's looking good. He's now tracking up fine on that leg and looks pretty sound. He's also not showing any sore spots on his rear.

Have a lesson on him tonight with a new instructor and I'm going to concentrate on getting him working correclty to improve his topline and rear end muscle. All gentle work at first. I'm also off on holiday for a long weekend so he's going to have even more time off (not that he cares!!).

Fingers crossed the injection (or maybe just the rest he's had) has worked. Won't know until I start working him again. Going to take it slowly and build up the work nice and gradually and keep an eye on that leg from now on!

 

[letrec_fan]

Sounds like he is doing well after the steroids. My boy has just had steroid injections into both hocks and he is like a changed horse.