Stifles destabilising AFTER steroid injections! Any experiences out there?

[Floofball]

Apologies for the long post but any experiences, advice or feedback would be greatly appreciated

My younger walking vet bill is really struggling with sticking/slipping stifles following steroid injections into both a few weeks ago.
A bit of history - he was ‘off’ last year and becoming increasingly unhappy ridden. Vet work up found large bone chip in his right hock. Surgery was recommended - as the cause was thought to be OCD I asked for everything else to be x-rayed before agreeing the op. Feet, fetlocks, knees & stifles all clear so off he went. Returned with an ‘excellent prognosis for return to full athletic function’. Following box, pen, small field rest he went for his post op check expecting to get the all clear for return to work. Sadly still lame but investigations couldn’t pin point where. No change in lameness after a bute trail (although he was much happier in himself!) Referal to specialist, bilaterally lame behind, 1/10 & 2/10 right slightly worse (why is it always bilateral! So hard to spot ) Blocked sound to the stifle. Scans showed mild cartilage changes/irregularities, possibly from previous OCD when younger, but nothing too worrying. It was noted that he was weak and needed strengthening. Low dose steroid injections were given and we were sent home with an in hand strengthening plan and to be seen again in 6 weeks to reassess/get the ok to get back on.
2 weeks into the rehab I noticed he started collapsing his right hind occasionally and both stifle joints started clicking in and out a bit when doing his physio stretches. Physio said stop doing those but carry on with groundwork plan. Then right stifle started locking up which was alarming to see (had this horse 4 years and it’s never happened before) Got vet back out who’s wasn’t that concerned about his wobbly joints but when he checked him he was still lame right hind. It was only 3 weeks after medicating so he said still early days, carry on with the groundwork plan but don’t start trot work yet. Another 2 weeks on and horse becoming reluctant to walk up/down the hills or raised poles. Both stifles collapsing/clicking in and out at the slightest movement, physio back out and when I went to get him out for her - his left stifle locked! He was also still lame right hind. So we’ve stopped strengthening plan as don’t want him to work the wrong muscles and we’re back to vets next week. Horses

I’m very deflated, it’s not nice to see a horse looking so compromised. He still rolls and lies down every night but I have such a bad feeling now having been so optimistic that surgery was going to fix all our issues. He’s only 8.

I can’t find much information apart from the continued use of steroids eventually compromising joint health - not the first injection? Hoping others might have experience, also any feedback regarding Alpha2 treatment? Not insured now neither - that’s a whole other story!

 

[ycbm]

I have had a similar bad result from injecting steroids into an arthritic fetlock.

I think the likely reason is that if the area is inflamed it's cushioned by fluid and in your case also kept tight by the fluid. Take the fluid away and bone can meet bone in my case, and in your case the joint can go unstable.

I'm sorry you've got this result, I hope you can find a solution.
.

 

[Floofball]

Thanks for the reply @ycbm thats exactly what I think may have happened but I didn’t know how to describe it. I’ve been trying to describe to the vets that it’s as though the steroids have relaxed all the support structures in those joints (which they seem sceptical of ) but what you’ve said makes a lot of sense. Rescanning has been mentioned for Tues, I’m now thinking re X-ray as well to check not bone on bone before considering other treatments! I have a horrible sense of doom about it, feel quite sick did you try anything else for the fetlock (assuming not much can be done if bone on bone) ?

 

[ycbm]

Thanks for the reply @ycbm thats exactly what I think may have happened but I didn’t know how to describe it. I’ve been trying to describe to the vets that it’s as though the steroids have relaxed all the support structures in those joints (which they seem sceptical of ) but what you’ve said makes a lot of sense. Rescanning has been mentioned for Tues, I’m now thinking re X-ray as well to check not bone on bone before considering other treatments! I have a horrible sense of doom about it, feel quite sick did you try anything else for the fetlock (assuming not much can be done if bone on bone) ?

No, he was catastrophically lame in walk a month after steroids, and although I had a vet desperate to spend insurance money on arthramid it was patently obvious he was never going to be sound on a front fetlock with extensive arthritis in and around the joint and bone touching bone on flexion in the middle of it .

I hope you get a better result.
.

 

[sbloom]

I wouldn't want to comment on the vet/diagnosis/medical side, but on the groundwork side my personal experience (and from LOTS of reading) is that so often the exercises we are given for rehab either do nothing, or add load. Adding load means making things harder, so polework and hillwork fall under that banner, and, if the horse's movement pattern isn't addressed, then they will keep all the other compensations anyway, and strengthen them even further. It's not just a reinjury etc, as you suspect you have here, that will cause this, it's compensatory movement patterns that underly so many injuries, and these affect other parts of the body, hence it's so common to have SI or suspensory problems with or after KS. Fix the movement problems first before strenthening.

If rehab is still indicated, once you work out what's going on, then have a look at Annie Dillon and Diana Waters on Facebook, there are others that are similar but to me these two get to the gentle fundamentals of creating healthy movement patterns. Diana has a free group, Slow Walk Work, on FB that has a whole thread on it on here.

 

[Goldenstar]

I agree with sbloom that the rehab recommended can be too much.
If somethings not working and you keep doing it sometimes things get better but sometimes I think it gets worse
Then you need to do less and do it clever standing correctly is so important and that’s the biggest thing that I watch for now horses tell us so much by how they stand.
When the standing improves you are getting somewhere .
I hope you can get through this.
Of course I can’t tell you what to with your horse but moving a lot in a outside space where he can’t gain weight would be something I would be doing
The company of other kind horses is underestimated this can really help horses heal .
We don’t give nearly enough thought to how much contact with a friend in a time of need helps a horse to heal its head and its body .
Massage would not cure a horse but it makes its feel better as can proper grooming with a body brush
The roll of the fascia is not considered nearly enough that’s why massage and particularly grooming can help some horses so much .
I am sorry you are going through this .
It’s crap many of us have been there .
It’s emotionally exhausting.

 

[sbloom]

I strongly believe that with most work if the horse isn't doing it correctly then you should find a different way, working through an issue almost always means tension, incorrect movement, and more to undo later. Why can't the horse do it? What else should I be working on first....work on what does show correct balance and movement and everything else gets kind of dragged along in the background anyway.

Observing the horse's stance every day is definitely part of good monitoring, and everyone should be doing it. The squarer they stand, on average and not just one-offs, the better their bodies are likely to be moving.