Unexplained hock injury - Please send vibes

HufflyPuffly

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Please let me know any ideas as we're running out of options :(.

History is, 11th Jan this year she came in from the field completely none weight-baring, called the farrier as no cuts, bumps, swelling, heat etc. Morning and the farrier came, she presented with a massively swollen hock, was pretty much sound and no abscess to be found. Box-rested her for the next 5-7 days, swelling went down, she remained sound, so she went back out again (she is retired, so no work).

We put it down to messing about in the mud and she'd tweaked something.

Fast forward to 19th March (Thursday) and similar symptoms, brought her in almost none weight-baring and her hock was puffy. This time however, she has pretty much remained severely lame, so on the Saturday morning with no improvement I called the vet who gave her a pain relief shot and left me Danilon and booked her in for x-rays the following Tuesday. His guess was due to her age (27) it was arthritis that had become inflamed.

X-rays showed nothing really, slight evidence of some sort of trauma (can't remember the term the vet used, but it was something like small particles could be seen in the joint space indicating some trauma), but no bone chips, fractures or even much arthritis. They gave her a steroid injection into the joint, which also drained some of the fluid that had accumulated, and she walked away almost sound. Brought her home, the next day she looked worse but gradually looked better again (still on box rest). Instructions were to keep her in a week from the injection and then maybe we could look at moving her to a pen in the field. The following Tuesday, she got herself upset in the stable (had company but I took too long bringing Topaz back to her), and she was back to almost none weight-baring and has been since.

The Vets are stumped, she went back to them on Monday for a joint flush and drain and a course of mega antibiotics, they've also sent samples of the joint fluid for testing (should come in today). Similar as the steroid injection, walked away from the flush much better, yesterday looked ok, but this morning back to none weight-baring. Obviously we're awaiting the test results but I'm not sure what else we can do :(.

She can flex the joint fine and isn't sore bending it, but it obviously is excruciating to put her weight on it and Danilon + paracetamol makes no difference. Vets have no idea, can't really refer her at this current time and to be honest even with better diagnostics they're not sure what other treatment options there are, I also don't have unlimited money. Plus I am conscious this last episode (March to now) has been going on for nearly a month, and the last downturn has not improved at all in over a week of complete box-rest + pain relief. I just can't help think this might be it :(, it can't be a good sign that the vets are all stumped as to what the issue is.

I have no wine or chocolate to offer as I've consumed everything sorry :(. Picture of my most perfect first horse who I want nothing more than to have more time with please.

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Pearlsasinger

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I am sorry for your troubles. In a similar situation, which bute just was not touching, and in desperation, I resorted to magnetic leg-wraps which were miraculous. From shuffling/hopping in, she went to trotting in apparently sound in 24 hours. It is awful to be in this kind of limbo, not knowing what is the problem and wondering how much longer you can let it go on for. <<<<Vibes>>>>>>> for you both
 

be positive

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Has an abscess definitely been ruled out? one here was lame in the winter and it turned out to be 2 problems on the same leg, he had fractured his splint bone but also had an abscess, vets were stumped at first as he was lamer than expected from the fracture, improved then got worse, it actually took months to fully resolve as the treatment for each was different which made it tricky to get right, worth a check just in case, she is non weight bearing but ok flexing it which doesn't quite add up.
 

HufflyPuffly

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I’m so sorry to hear this about your old girl. You have tried everything that you can do in the current lockdown. If she can’t be made comfortable...

I thought that I was losing my old girl on Saturday. It is horrid.

:( hope your oldie is ok.

I am sorry for your troubles. In a similar situation, which bute just was not touching, and in desperation, I resorted to magnetic leg-wraps which were miraculous. From shuffling/hopping in, she went to trotting in apparently sound in 24 hours. It is awful to be in this kind of limbo, not knowing what is the problem and wondering how much longer you can let it go on for. <<<<Vibes>>>>>>> for you both

Tried it, plus ice vibe boots and made no difference.

Has an abscess definitely been ruled out? one here was lame in the winter and it turned out to be 2 problems on the same leg, he had fractured his splint bone but also had an abscess, vets were stumped at first as he was lamer than expected from the fracture, improved then got worse, it actually took months to fully resolve as the treatment for each was different which made it tricky to get right, worth a check just in case, she is non weight bearing but ok flexing it which doesn't quite add up.

I've discussed this with the vet, but it does seem to temporarily improve when the joint is drained, indicating it is the hock that is the problem. I took her shoes off in case it could still have been an abscess but she's not reacting at all to her hoof, we've all poked, two different farriers, vet and myself :(. Could ask for an x-ray of her hoof just in case, she does have a large crack on the hoof of that leg (hence the shoes went on), but it doesn't look to be causing any discomfort...
 

ester

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Oh Doodle, we can't diagnose and treat everything sadly :( and it certainly seems indicative if it is better when drained. Wait for the fluid results and then you have all the information. If you wanted even if they can't refer her they could send up the diagnostics for another opinion?

I have spare wine, no spare chocolate though.
 

SEL

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I've spent the morning in tears and desperately hoping for an abscess so you have my sympathy. It's a really sh1t time to have a sick horse.

There's no chance of any blackthorn in the hock is there? My YO had a horse who was catastrophically lame with the tiniest of scratches near its hock. A poultice drew out this minute bit of thorn - apparently toxic and can cause reactions. Probably a long shot......

I'd x ray the hoof before you make any decisions just in case there's an abscess that can find an exit.

Keep us posted xx
 

HufflyPuffly

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Oh Doodle, we can't diagnose and treat everything sadly :( and it certainly seems indicative if it is better when drained. Wait for the fluid results and then you have all the information. If you wanted even if they can't refer her they could send up the diagnostics for another opinion?

I have spare wine, no spare chocolate though.

Thank you, I could ask if they can send them on, but I don't think there is anything even usual in the diagnostics so far that could cause a difference of opinion. The senior vet at the practice is now involved in her care and he is stumped too, especially on the normal flexing abilities but none weight-baring. Just hope the samples show something...

I've spent the morning in tears and desperately hoping for an abscess so you have my sympathy. It's a really sh1t time to have a sick horse.

There's no chance of any blackthorn in the hock is there? My YO had a horse who was catastrophically lame with the tiniest of scratches near its hock. A poultice drew out this minute bit of thorn - apparently toxic and can cause reactions. Probably a long shot......

I'd x ray the hoof before you make any decisions just in case there's an abscess that can find an exit.

Keep us posted xx

Oh no, I will send my puss vibes to you too! I have looked and looked and cannot find anything, I guess if there is a foreign object it would show in the joint fluid tests? I'll suggest x-raying her hoof if the samples don't shed any light :(.
 

chaps89

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Oh poor Doodle. (And poor you) I think I'd also be x-raying further down just incase. Has she had an ultra sound scan of the area/might that be worth a try incase it's soft tissue rather than bone/joint?
Can you give her leg a really close clip so you can get a really good visual just incase there is a small foreign body lurking? (My mare got a hawthorn splinter in her stifle once. Couldn't work out why she went ballistic every time I brushed a certain area as I couldn't feel or see anything. Had the vet and as soon as it was clipped we could just see an end poking out. Long shot that it might be the same sort of thing but worth a try?)

Also, SEL, hope yours improves too
 

Fragglerock

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Some years ago I was told about a horse that had a problem in it's front leg - they treated for that problem and missed it had fractured the shoulder. Could it be a problem elsewhere? Has the hock been scanned?
 

Roxylola

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Nothing much to lose by xraying the hoof, how long for the samples? And how long have they had them?
Have you 100% ruled out anything higher up? Weird question I know but maybe something higher causing swelling and the swelling is causing the hock pain.
It's awful but as things are if you can rule those out then I don't think I'd be going much further while she's in pain. Sorry :(
 

ycbm

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She can flex the joint fine and isn't sore bending it, but it obviously is excruciating to put her weight on it and Danilon + paracetamol makes no difference.


Are they sure it's not the foot?


ETA, Sorry, I see this has already been asked.

.
 

Roxylola

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Still not heard about the test results yet, but will press about investigating other areas when they call.
I think they suggest to allow a couple of weeks for samples, it's really just in case, generally if they are doing cultures and they find something it will be sooner not later. If it has been a week or more I would be preparing myself that they likely haven't found anything
 

HufflyPuffly

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I think they suggest to allow a couple of weeks for samples, it's really just in case, generally if they are doing cultures and they find something it will be sooner not later. If it has been a week or more I would be preparing myself that they likely haven't found anything

Ah sorry should have said the vets were expecting the results either yesterday or today, so not sure if they've fast tracked them? They're keeping her at the vets until the results come back?
 

AandK

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Have they ruled out soft tissue? My 7yo had an injury to his lateral collateral ligament (runs down the outside of the hock and helps keep the joint stable) last year, it wasn't a complete rupture but there was swelling to the joint, he wasn't as lame as your girl but worth asking about.
 

ihatework

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What is it they are draining, a build up of fluid around the joint I presume? I wonder if that fluid is pressing on a ligament/tendon - have ultrasound scans been done?

If you had a septic joint i doubt the horse would still be here.
 

HufflyPuffly

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Can’t rule out soft tissue but it’s not responding to treatment as expected so vets are a bit stumped. 3 weeks solid box rest + a lot of pain relief + steroid injection should see ‘some’ improvement.

They’re wondering on a low level infection potentially, which is why we’ve had slight ups and then back to very lame again.

Samples are currently missing ?, blamed on the Coronavirus impact. So new plan is if samples haven’t turned up tomorrow to redo take the samples but also start nerve blocking to see if we’re just looking at the hock or if there is more than one issue at work.

It looks to be just joint fluid that’s causing the swelling. A septic joint is what we’re trying to avoid, but shouldn’t be the original issue.

Feeling a bit better for having a plan, even if it’s still clutching at straws.
 

Flyermc

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OMG i could have wrote this about my boy.

i dont have an answer and it wasnt a good outcome for us. He had the 'massive hock' from 'something' he did in the field, but not really lame to start with. The xrays that didnt show much, draining that helped briefly, steroids that didnt do much, bute that didnt overly help, joint fluid tested that showed nothing.

I really hope you get an answer
 

SusieT

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I would nerve block to confirm it is definitely the hock - as if it is and something bad enough to have repeat non weight bearing lameness in a 27 yr old I would euthanise as its unlikely there will be a quick welfare friendly solution
but if it was further down it could be a persistant abscess or similar- better to know where it is coming from
 

horselover11

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Have you had antibiotics at any point. If they flushed the joint and are awaiting for the swab results to determine best antibiotic maybe they should start treatment with doxivet solution or paste? That’s what my vets did for one of mine. I would say try mri but that’s expensive ?
 

DabDab

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I've no useful suggestions, other than, as others have suggested, maybe there is an issue elsewhere in the leg and the pain and inflammation in the hock is from compensating and then becomes an issue in itself. But sending vibes to you and doodle xx
 

MuffettMischief

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I have had the EXACT same issue with one of ours who we sadly lost (not just due to the leg but for a few reasons). It was the collateral ligament in his hock. Had two vets, my vet and the owners vet (loan horse), both brilliant vets and both said they had rarely seen this injury. Maybe a mention to your vets. Best of luck
 

HufflyPuffly

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Not a good update, she is still extremely lame and the leg is now filling.

The joint fluid samples however, were found and the results came back as expected, very high white blood cell count, but cannot say for definite if its infection or just an inflammation reaction, nothing else was found. They've palpated her leg to see if there could be reasons elsewhere for pain and haven't found anything, she is very reactive to pain so it 'should' be obvious.

They're going to flush again and inject the antibiotics directly into the joint capsule just in-case the IV ones aren't getting through. Nerve blocks are out for the moment as she won't stand for them without sedation and you can't sedate and nerve block. If no better tomorrow (5th day of IV antibiotics), then they will flush again and also x-ray her hoof whilst she's sedated, but to be honest none of us really think there is an abscess or other issues, as draining the hock has temporarily improved it each time, so suggests it is the main issue.

She's also been hoof tested several times and had her shoes removed, she's not sore at all in her hoof, but we will x-ray to rule it out.

:( If the antibiotics don't work then we're pretty much out of options, she's had max strength pain-relief, box-rest, steroid injections, joint flushes and three weeks in shes not improved. Even if we do more imaging now the vets have said there aren't any treatment options left that we've not tried, a soft tissue injury should have had 'some' improvement by now. If we send her off for scans we might get a better answer of what is wrong but it wouldn't give us another treatment option that's fair to put her through.

I am thankful for all your replies and suggestions though. I have asked about all the ideas given and we cannot rule out something like the collateral ligament the treatment she'd had should have done something to improve it...
 

milliepops

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What a rubbish position for you to be in, sending more hugs and another dose of healing vibes, come on Doodle xxx
 

HufflyPuffly

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Tentative update of that she apparently looks better today ???. We’ve been here before after a flush, so it’s riding on how she looks tomorrow, vet is being optimistic that if she looks good tomorrow they will flush with antibiotics again and she might come home Sunday. I can’t dare get my hopes up ?.
 
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