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Case Study: Equine Stifle and SI Lameness

Lameness in the horse can come in all different forms and severities.  One common source of lameness is the stifle but in many of these cases, it is also common to have problems either higher up or lower in the limb often tied in with conformational flaws or even trauma.  The saccroiliac region in the lower back or hip region is also a common source of discomfort, either alone or in conjunction with other problems.  The saccroiliac (S/I) joint is the area where the pelvic bone called the Ileum joins up to the Saccrum of the lower back.  The junction of the two is actually termed a joint, being held together by tough fibrous tissue, but still demonstrates some movement as the horse travels.  In a recent case presented for rehabilitation, we actually had apparent S/I problems in addition to chronic stifle lameness. When combined with unhealthy feet, severe thrush and sole pain, the case proved to be a real challenge.

Edward is an 8 y.o, 18.3 hh TB gelding that had a history of ongoing lameness in the right rear limb since he was started in work at the age of 3 years. The current trainer/owner had acquired him from the original owner and unfortunately, his complete history was unknown.  As he was put into work, an evident hitch was noted in the right rear, which was investigated by the attending veterinarian.  At times, he would actually show fluid distension or accumulation within the stifle with pain.  Regardless of obvious effusion and lameness, an accurate diagnosis was difficult to make as standard radiographs were inconclusive.  Edward received a series of joint injections and even stem cell infusions over a period of a few years and put back into hill work, hoping to strengthen the area and his hind end.  Therapies were not providing the results that were anticipated and he was donated.

On initial examination, Edward was noted to be a big guy with adequate bone structure and proper angles, however, one of the biggest problems noted was a lack of proper muscle development over the pelvis and hind quarters, despite having a good body condition score overall.  He also had an evident hunter’s bump and was graded a 3-4/5 lame at the trot on the right rear with obvious hitch.  Stifle flexion seemed to add to the lameness but not to the significant degree that we had expected.  Upon further evaluation, he was currently shod but the shoes were removed. His hoof angles were acceptable, but upon removing the shoes it was noted that he had severe thrush and white line disease in 3 of 4 feet, with both of the rear affected.  The frogs were eroded away with evident discharge and even some pockets of abscessation.  He was strongly positive to the hoof testers over the frogs and heel region, which when nerve blocks were performed, seemed to indicate that these problems were actually contributing to his overall lameness at the time as his score did improve.

The exact cause of his ongoing lameness to the right rear was not determined as prior diagnostics, including x-rays, were inconclusive. The right stifle did appear to be a component, but we were not sure if it was the sole source of lameness. Given the evident hunter’s bump, it was also suspected that he had prior pelvic trauma with possible subluxation of the Ileum, which could possibly contribute to the lameness due to limb length discrepancy and destablization to the region. Nerve blocks were not performed in the SI region and he was managed conservatively given the chronicity of his lameness.

Edward was started on a high quality hay with whole cereal grains.  Given the lameness and association with an unmanaged inflammatory response, he was also started on the Cur-OST® EQ Plus formula to help reduce discomfort and ideally promote healing.  His feet were trimmed and damaged frog tissue was removed with daily soaks to encourage control of the infection.  Cur-OST® EQ Immune & Repair was also added to his regimen to support overall healing but to enhance the immune response for purposes of aiding in clearing the thrush.  He was started in light work almost immediately, 3 times per week.

Over the next 30 days, his foot soreness dramatically improved and routine barefoot trims were applied with continual removal of affected frog tissue.  The soles and frog began to slowly dry out and toughen up, which aided in his comfort. His lameness improved to a grade 2/5 at the end of 30 days and there was no evidence of stifle swelling.

After the first 60 days, Edward was continued on a daily regimen of the Cur-OST® EQ Plus to help promote a healthy inflammatory response.  The EQ Immune & Repair formula was discontinued but he was continued forward on the Cur-OST® EQ Nourish formula to help provide additional protein and amino acids for further tissue repair and muscle development in the topline and hind quarters.

As of the time of this writing, Edward is doing fantastic and currently jumping 3′ 6″ with ease.  His rear lameness is almost completely resolved and he is comfortable and very willing to work. Edward is maintained comfortably on a daily regimen of the EQ Plus and EQ Nourish formula along with a whole food diet.  His feet are completely healed, angles are great and he is maintained with a barefoot trim.

Traditional therapies for stifle and S/I lameness cases include repetitive joint injections with steroids and hyaluronic acid, in addition to long term stall rest if indicated.  All of these therapies and more were employed in Edwards’s initial recovery efforts with no long term improvement.  All that we have done is address his body as a whole, including feet, nutrition and aiding in long term support of a healthy inflammatory response.

The take home message in this case is that often lameness can be hard to pinpoint.  We have to remember that inflammation is tied into every case of lameness and contributes not only to the discomfort but also opens the door for tissue weakness and joint deterioration.  In many instances, diagnostics are inconclusive, meaning that an exact problem cannot be determined.  Often, it is not just one specific issue, but more so a multitude of problems as evident in Edward’s case.  Just because we may not be able to pinpoint a specific problem, that does not mean that inflammation shouldn’t be managed. Sometimes, if we just control the inflammation, the lameness improves without further measures.  In instances such as Edward’s, we have likely damage to the S/I joint, which is chronic in nature and unlikely to be reversed.  He may always have a slight hitch to the right rear, but the goal is with healing, the area becomes more stable and comfort is restored.  The long term hitch may actually be a sign of limb length issues more so than pain, and at this time, is a very minor issue and won’t be a deterent to him moving forward in his career.

 

I hope this case helps to demonstrate the possibilities for recovery!

All my best,

Tom Schell, D.V.M.

Nouvelle Research, Inc.

www.nouvelleresearch.com

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