What are the options now?

[Sail_away]

Feeling a bit lost really. Paddy had steroid injections in his hocks plus cartrophen IM around three weeks ago (cartrophen was injected at the time and in the subsequent weeks). He felt comfortable in work though the leg with worse changes (still mild) was still weaker. But in the last few days it’s clear they’ve worn off - he’s not lame but he’s not enthusiastic about work anymore and his performance has dropped. Bute doesn’t help him to a level I’d be happy to work him at. So - what's left? Would this be a case for gel/arthramid injections? I've contacted my vet but he hasn't had a chance to reply yet. Really just looking for reassurance that there's other treatments left; I’m pretty confident it’s been rumbling on for 18 months or so but started hurting now as he lost a lot of muscle earlier in the year when on rest for other issues. So I wouldn’t be happy with just leaving him to light hacking/retirement on bute.

 

[SEL]

I found the gel injections loads better than the steroids. We did put a little steroid into the SI joint despite no real changes on the ultrasound and she really started to use her back and properly.

Unfortunately being a horse she then injured a foreleg but once that seems to have improved we'll redo the SI steroid to see if that helps build up muscle - which will help the hocks.

 

[rabatsa]

Mine was retired as the injections wore of very quickly. He is happy as a companion but if/when he starts to be uncomfortable just mooching then he will be pts.

 

[LEC]

If injections are wearing off that quickly then realistically you are running out of options, especially if you don't want to bute. Anything you do will be a short term sticking plaster.

 

[Sail_away]

Thanks all - I’d really like to try gel injections if it’s a viable option but it was a bit of a shock the steroids wore off so quickly even with cartrophen. Especially as it is so, so minor - our vet’s experienced and he said he usually sees joints much further deteriorated than Paddy’s.
He’s only eleven. Three weeks seems so short it makes me wonder if there’s other things going on - but then again he responded very positively to nerve blocks in the hocks.

 

[TotalMadgeness]

My boy is 11, has bone spavin in both hocks and is currently on osphos. This may be an option for yours. For my horse the steroid injections wore off very quickly too and my vet isn't a fan of the arthramid gel (he says once you inject that your other treatment options are reduced). My horse is comfortable on 2 x danilon a day but long term this isn't a great option - so we went for the osphos. The next option may be fusing of the joints.

 

[Sail_away]

My boy is 11, has bone spavin in both hocks and is currently on osphos. This may be an option for yours. For my horse the steroid injections wore off very quickly too and my vet isn't a fan of the arthramid gel (he says once you inject that your other treatment options are reduced). My horse is comfortable on 2 x danilon a day but long term this isn't a great option - so we went for the osphos. The next option may be fusing of the joints.

I haven’t heard of osphos - would you mind explaining what it does? From what I’ve read about joint fusion I’m not really comfortable with the procedure - to be honest I’d retire or pts before that.

 

[LEC]

I haven’t heard of osphos - would you mind explaining what it does? From what I’ve read about joint fusion I’m not really comfortable with the procedure - to be honest I’d retire or pts before that.

Everyone should read Dr Ramey his stuff is excellent.

Tildren® and Osphos®- More Concerns - David Ramey, DVMDavid Ramey, DVM (doctorramey.com)

Personally, looking at your horse in the photo I would be looking to see if I could sort out the plantar angles. He is very straight in the hock. Read The Equine Documentalist on the work which has gone on which involves plantar angles and the impact on the horses body.

 

[Sail_away]

Thanks LEC that was very interesting. Re the photo, it’s from over a year ago and his feet look significantly different now though I will raise it with the vet and farrier.
I’ve spoken to our vet however and he suspects the hocks are not the only issue given the mildness of the arthritis. He’s going to liphook when they have space for a nuclear scintigraphy of his hinds to get a broader picture. Not feeling super positive considering the number of issues he’s had this year but we owe it to him to try to solve it.

 

[Sail_away]

He's off to liphook on Sunday now for the scan on Monday, he stays there for a couple of days until he's not radioactive and then he comes home. Now I've had a chance to process info, our vet seemed to be suggesting it could be a suspensory issue - though of course he was clear nothing definite could be said until the scan was done. Reading up it sounds like it would be chronic PSD if this is the case - google is fuzzy about treatment/prognosis - does anyone have experience of a long-term hind limb PSD and what did they do about it? My main concern is that none of the options seem to have a great success rate - and Paddy, bless his heart, is one of those horses where if something can go wrong then it will. It's so frustrating because all his issues seem to be so minor but really I know it's just because he tries so hard. It seems like we've been on a downwards spiral this year with each successive issue turning up other issues.

 

[Sail_away]

Argh. Good and bad news - scan showed nothing we didn’t know, just the hocks again. It’s good to know there’s nothing catastrophic going on but if that’s the case why didn’t the steroids work. Ultrasound of the suspensory ligaments next week but I guess if nothing shows up we start exploring other options for the hocks. Gel injections sound the best option so far but I’ll talk to my vet after the ultrasound.
Anyone know how likely a chronic suspensory ligament injury would be? He’s been off on that right hind twice previously in two years so in hindsight it makes me think it’s been something underlying. The arthritis is so minor the vet thought it would’ve been there for a few months only. So I’m thinking the arthritis was caused by another underlying stressor which is the real issue - because of the relative mildness, time frame and also how quickly the steroids wore off. But to be honest that’s just my gut feeling - I don’t know enough about suspensory injuries to say much at all.