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Starting 2022 with an Arthritis Diagnosis

Scottie just before his arthritis diagnosis

If you follow us on social media you might have already seen that just as I finally got round to clipping Scottie, I noticed he wasn’t quite right behind. He was really resting his right hind a lot more than usual. Every time I moved him he went straight back to resting that leg. While he is normally resting a leg, this was quite unusual behaviour for him. Plus I had thought he had looked a bit stiff in this leg a few weeks before. So I had the vet out for a look.

While I knew he wasn’t right, I was quite surprised when the vet said he was 4/10s lame on this leg. I know hindlimb lameness is harder to spot and I didn’t see him trot up as I was leading him. But Scottie isn’t a lame horse. When he has been lame, unless there has been an obvious wound he’s not been worse than 2/10s lame. So I wasn’t expecting him to be quite that sore on it.

There was absolutely no signs of any discomfort in his leg. So the vet suggested a weeks box rest with bute and see how he is. The theory being, if it improves there is probably a soft tissue injury somewhere what might have been niggling him for a while what he has suddenly made worse being silly in the field. If he didn’t get better, it would more likely be something like arthritis, his guess being one of the most common forms in the hock.

About 5 days into box rest I noticed his hock was getting quite warm and around day 7 it started to swell up. I spoke to the vet and decided that the next steps would be to nerve block to see where we think the problem was, as while the hock was now showing signs, it could have been a secondary condition caused by being in. Unfortunately these types of investigation take time and he couldn’t fit us in until the following week.

After nearly 2 weeks of box rest, we were finally able to look at Scottie a bit closer to work out what was going on. On his initial trot up he was still 4/10s lame, so no improvement from rest and bute. He had both hocks flexed and was worse on both legs after these. Seeing him on the lunge was quite interesting as this is one of the few times I really get to see what he looks like.

On the left rein I couldn’t really see much. Maybe a bit of uneven dropping through the pelvis. But I will be totally honest and say I didn’t see much if anything. On the right rein I was seeing more of what I had seen briefly before in his right hind. In the past he had worked through it quite quickly and improved to the point where I couldn’t see it. But this time it didn’t go away and looked a bit worse than what I had seen.

Turns out he was about 4/10 lame on the right rein and 2/10 on the left! This was a bit of a reality check into how hard it is to spot hind limb lameness when I am able to spot when Scottie is 1/10 lame in front! But it’s good now to have a better picture of what it looks like so I can look for it in the future.

After watching him move, we moved onto the next steps. The vet gave Scottie a thorough examination. Feeling his back and both back legs from hoof to pelvis. The only thing he noted was fluid in one of the hock joints. I think the proximal intertarsal joint.

Hock joint diagram
1. Proximal Intertarsal Joint, 2. Distal Intertarsal Joint, 3. Tarsometatarsal Joint, 4.Tibiotarsal Joint

Because he only found something small, the next step was to nerve block to rule other areas out. He blocked the lower hock joint, the fetlock and below before finally the joint he had some fluid on. There was no improvement with the first 2 blocks. On the final block, there was joint fluid pushing out, showing that it was swollen and Scottie was a bit agitated when the nerve block was first put in.

When it came to trotting him up we saw a small improvement. He went from 4/10 to 2/10 lame. He also didn’t go lame in his other hind leg, which is always promising. Sometimes it can be really hard to see bilateral lameness until you nerve block the worse leg. While he wasn’t sound, he improved enough for us to believe that this is the most likely cause of the lameness. The vet suggested that the two intertarsal joints are quite closely linked. So he might have a problem in both but we only blocked one. Although there is always a chance there is another problem else where.

The next step was x-rays. While he didn’t go lame in the other leg after a nerve block, at this point arthritis seemed like the likely cause. This is usually bi lateral, appearing in both legs, and he did have positive flexion tests on both legs. So the vet decided to x-ray both hocks as even if there isn’t a problem in the other one, it’s good to have a record of both.

Scottie’s x-ray showed some minor changes to the two intertarsal joints in his lame leg. There were also a few slightly pointy edges when they should be more square. But it wasn’t clear if these points were him or wear and tear. But on the whole, there was very little there, suggesting it is still the early stages of arthritis what effects the cartilage rather than the bone. His other hock looked clear, maybe some very early signs but not much there.

diagram of tarsal bones
Diagram of the Tarsal Bones involved in the Distal Intertarsal Joint.
A. Normal looking bones. B. Slightly pointed bones similar to Scottie’s x-ray

Our vet is going to double check the x-rays back in the office and let us know if he sees anything else. But he is fairly confident we have found the problem and we have started making a plan. There are so many treatment options available for arthritis now and since Scottie seems to be in the early stages, they are all available to us.

We are starting simple. Steroid injections are one of the most tried and tested treatments for arthritis. They are also fairly cheap, which is a factor as unfortunately Scottie isn’t insured for this. They can last anything from 6 months to 2 years. So we will play it by ear how well Scottie copes with it. There are also gels what can be injected to help protect the cartilage, which I am considering. Although I wonder if it is something we would try with our second injection rather than our first. I haven’t quite decided yet. But we have to wait 2 weeks until he can have his steroid injection, so I have time to make a decision.

In the meantime, Scottie is on bute to help keep him comfortable and back out in the field. Keeping horses moving in low impact activities is better for arthritis than just resting. So I am hoping to get him out every day and walk him in the evenings as they come in at lunch during the winter. Once he starts to look more comfortable we will start bringing him back into real work, starting with long reining then getting back on. Currently there doesn’t seem to be any reason why we can’t carry on working towards our goal of getting back to low level dressage, if anything it might be better for him!

I wonder if part of the reason it has flared up now is he has been moving less and the weather has been cold and damp. I caught covid mid December so was isolating. While Scottie was looked after, he was coming in at lunch and staying in until the morning. Then with the busy Christmas period he had a few more days in than normal. So he had a few factors going against him.

Me being me, I’m going to do a bit more research into anything else I can do to help keep him comfortable. I am a fan of magnetic therapy. So I am going to start looking for some magnetic boots what go around the hock. I already have a few for the lower leg I will use until then. I’m also going to do a bit of research into nutrition to see if there is anything lacking in his diet which could help him too.

While arthritis is never an ideal diagnosis, I always expected Scottie to get it. I read a stat recently along the lines of 40% of horses over 15 have arthritis, but don’t quote me on the exact numbers! So turning 14 this year, having been a national hunt horse and not having the best conformation, it does feel like the odds were stacking up against him. I also feel fairly confident that there is a lot we can do to keep him comfortable and keep him ticking along in low level work. But I will of course keep you all updated.

Scottie enjoying his first day out after his arthritis diagnosis
Scottie enjoying being back out

Last Updated on 14/01/2022

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