A much loved and respected friend had had good results with RJ a vet with a different take on stuff, my vet Liz was happy for Chorrie to see RJ but didn't think he'd be able to do much and how right she turned out to be. If only I'd listened so RJ came and saw and failed to listen to me and told me Chorrie had significant pain on flexion of fetlock joints.
So of course I went into headless chicken mode, believing I'd let Chorrie down, so I had Liz out to do a clinical exam and Chorrie trotted at the end of the lead rope so well under a 10m circle on the hard both ways and was SOUND as Liz said not many horses can pass that test and even fewer at 23.
The effusion is better than you'd expect for a 23yo, we imaged the neck and there is some arthritis but again nothing remarkable for a 23yo
So lesson is trust the team you've assembled there isn't always a fix, however time has helped and we're back to normal with picking feet up
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Long-standing reluctance to pick up front limbs; recently deteriorating and farrier finding it increasingly difficult to shoe in front – that said, much of the reluctance to lift limb can seemingly be overcome by protracting the limb to lift it, rather than simply “picking it up”. When front limbs can be elevated, horse shows an (involuntary?) muscle shudder through the ipsilateral shoulder, a marked head and neck lift of approximately 50cm with opening of the oral lips, and he will then typically turn to bite at (particularly right, which seems to be worst affected side) shoulder region.
Appears happy to lift both hind limbs normally. He adopts a slightly over-at-the-knee stance. No digital pulses were palpable (although a previous supporting limb laminitis had been reported in association with a recent check-ligament sprain.)
Problems are reportedly worse in cold, wet weather; 1g of oral phenyl-butazone daily has allegedly made no difference to any of his conditions.
Initial led walk away from stable produces noticeable base-wide action in all limbs, reminiscent of some cases of inco-ordination, paresis or reduced proprioception; however, the base-wide movement is not sustained and more normal action is displayed within minutes of commencing led walking exercise. Lateral sway tests negative, horse reins-back well and a jumbled grid of trotting poles at different angles, some on the ground, some elevated at one end was negotiated with ease and good foot placement from all limbs.
Blinfolded tests were not performed but genuine ataxia did not appear to be present.
Led trot was unremarkable. Hind limb crossing action on tight circles was unusual in that the inside leg on each rein executed a smooth protraction-adduction movement with each stride over a good range of movement, but the outside limb on both reins stumbled consistently with each protraction-abduction stride.
On palpation, bilateral stiffness was found in the lower (C4-C5-C6) cervical vertebrae with no appreciable lateral movement through this area; marked bilateral triceps muscle spasm was evident (but minimal hypersensitivity around withers); bilateral longissimus lumborum tension – possibly mildly spasming – and small amount of increased tension in both middle gluteal muscles (possibly slightly more noticeable on right side).
These findings were discussed with the horse's owner. Because of the unknown nature of the lower cervical vertebral blockade and the mixed bag of clinical signs (some possibly suggestive of neural component, others simply not) it was mutually agreed that primary mobilisation of the lower cervical region would not be attempted prior to further diagnostic work being conducted on the area. Efforts were therefore focused on relieving the tension in the lumbar and caudal shoulder regions, as follows:
Firstly, the lumbar area was successfully manipulated and mobilised, resulting in an immediate relaxation of the tight longissimus and gluteal muscle groups. Repeated led walk and trot exercise demonstrated a significant elevation in hind limb movement, with increased axial rotation around the sacrum and lateral excursion of the tubera coxae.
Secondly, the shoulder regions were successfully manipulated and mobilised, resulting in an immediate relaxation in both triceps muscles and a cessation of the mild hypersensitivity previously seen at the withers. During mobilisation, the dorso-palmar range of movement in the proximal forelimbs was shown to not be unduly restricted; similarly, there was no evidence of pain or abnormal physical restriction to passive movement of the proximal limbs in any other plane. Full extension of the carpi appeared to be physically restricted, although no pain was elicited in the attempt; passive carpal movement in all other planes appeared normal for the horse's age. Bilateral effusions were noted in the proximal fetlock joint capsules, and a degree of puffiness was noted around all four distal limbs. The horse very much resented fetlock flexion, to the point of reproducing the previously witnessed head and neck lift with mouth opening each time either front fetlock was flexed; this could be reproduced with the proximal limb flexed, neutral or extended, suggesting that the pain was entirely focused on the fetlocks themselves. Interestingly, Chorister appeared entirely comfortable and relaxed with each fore limb lifted in full extension (notwithstanding the restriction in his carpi); it was decided to perform gentle lateral excursions of the head and neck whilst each forelimb was held in full extension; these manoevres can be performed by the horse without having to recruit painful of physically restricted vertebral segments, but Chorister did perform lateral bending of the neck from C1 to C5, and the C4-C5 segment was noticeably more relaxed afterwards.
Repeat led walk and trot showed improvements in proximal forelimb suspension and freedom of movement. On tight circles on both reins, the inside limb movement was still good and there was a noticeable improvement in the action of the outside limbs, with less stumbling movement. Crucially, Chorister appeared a little more content to lift his fore limbs; even with a conventional lift-retraction approach. When elevated there was less proximal musculature shuddering evident, and he did not turn around to bite at his shoulder. It is not known if this apparent benefit will be sustained for any length of time.
The effusion in, and the significant pain on passive flexion of, the front fetlock joints is considered worthy of further investigation. It is unknown what part this discomfort might be contributing to his reluctance to pick up his feet (or, indeed, if it plays any part at all) but they would appear to be the anatomical areas that are causing him the most trouble at this moment. An apparent lack of response to 1g of phenylbutazone is probably insufficient to rule-out pain and inflammation in a horse of his size.
In addition, diagnostic imaging could be considered for the neck region (and particularly of C5-C6) since an absence of imageable pathology in this area might increase confidence in attempting primary manipulation and mobilisation of this area, although the relevance of stiffness in this area is not obvious.
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