Hock Injections - How long for a result?

Question
QUESTION: I have a 12 year old QH mare that has been unsound for about 6 months now. Before she went lame, I usually rode her 3 or 4 days a week and occasionally took her to a show where we jumped no higher than 2'6". She is a pleasure horse and I like to do a little bit of everything with her. The soundness issue is coming from the hind end. I have had my vet out a couple of times to look at her and he said it was her hocks and stifles and that she looked pretty bad. A little over 3 weeks ago she got stifle injections and 9 days ago she got hock injections. He said 3 days off, ride her lightly on the 4th day, and work her back slowly. Well, I have done that and the only thing I notice is that the lameness seems to be more concentrated in her hock and less in her stifle. I'm pretty sure he injected her with HA. Should I see any improvement by now? I've tried to research injections online and many people are saying that they saw results immediately. I've got her hocks injected twice before and I don't remember waiting this long to see them take effect, and I am very worried. I've done everything I can to prevent other issues from arising: saddle checked, 7 massages, and chiropractic work. When I get on her (since her injections) I walk her for 10 minutes and then try to start trotting. She is sometimes sound on straight lines but doing downward transitions and corners she seems to get "sticky" and will not move forward. (I know this hurts her and she is not a wimp so I stop and try again in a couple of steps.) If these hock injections don't work, are there any other options? Should I see her starting to get better already - because I have seen no change at all?

ANSWER: Jessie:

Really good questions and excellent recogniton of things going on in your horse. There are several issues here as I see it. First, you have not described much in the way of diagnositc evaluation of your horse which bothers me. I feel like Im very experienced in working up hind leg problems and in my hands, I need to do flexion tests and to do blocking of nerves and joints in order to verify where a lameness is coming from. Occasionally I do treat the hocks empirically because they are the most common site to be a problem in the back legs and they are associated with a typical appearance to the experienced lameness vet. However, as I tell everyone I do this for, if there is no response to treatment, the primary consideration is that you did not treat the real problem. This most frequently occurs when we try to make shortcuts instead of doing the complete evaluation, flexions and blocking- you treat based on your gut feeling and therefore there are times you are wrong. Second, im my hands, I find that using HA alone in the hocks is not worthwhile. These joints must receive steroid medications in order to reliably respond. Finally, I dont know anything about your vet, but it is not uncommon for less experienced vets to simply not ever get the medication into the joint. Injecting hocks is not a procedure just anyone can do right away. Joint injections, when performed skillfully, with the correct medications and administered to the correct joint causing the problem, produce clinical improvement usually overnight. Approaching this the way your vet has could have saved you time and money in the diagnosis and treatment of this lameness. But as occurs sometimes when you try to expedite the process like this, sometimes there is no response. This then requires stepping back and doing a thorough evaluation in order to specifically identify and prove where the lameness is coming from, then choosing the correct meds and using good technique to address the joint injection. You seem to be at this point where this is now necessary. I hope this helps you some. Feel free to contact me again if I can help you any further. Good luck to you and your horse.

---------- FOLLOW-UP ----------

QUESTION: Thank you for the valuable information! I guess I forgot to mention that my vet did perform flexion tests which led him to the injections. He actually came out again today - I was unable to be there, and I had a friend jog her and he said she looked sound (However, if I would have been there, I would have probably had him do a flexion, and he would have seen she is still off). She informed him on her "stickyness" and how she is sometimes sound, but overall has not improved. He recommended walk/trot for a week and try pushing her a little because just like any person going through some rehab, it may hurt coming out of an injury. If she seems ok, then the next week add a little cantering, if she seems in too much pain to trot then just walk, and if she doesn't improve in 2 weeks, he wanted to see her again. He did mention that I should see some improvement by now. I am keeping an open mind and trying to figure out if we are not treating the problem, then what is the actual problem that we need to fix? I guess my question now is what underlying problem can cause weak hocks? Would you recommend taking her to a facility like Michigan State or Rood & Riddle if she does not improve?

Answer
Jessie:

If it were the hocks and the injections were done appropriately, the horse should be fine by now. If this persists, it needs to be specifically diagnosed. It is not necessary to go to a referral center right away for this. Such a move is likely to be a good bit more expensive than using a good lameness vet. That said, maybe your horse is now working out of this but I still dont feel that you have a diagnosis yet. If you decide to use another vet, you certainly wouldnt go wrong by using one of the proposed institutions. Also, if you are interested, I am also in Kentucky very near Rood and Riddle and I could come to you or make arrangements to see your horse here. Feel free to call me if you feel I could help too. Bluegrass Equine Performance and Internal Medicine, LLC; (502) 370-7413. Thats my direct cell phone if you need to get ahold of me to help you in any way.