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Ailments
A four-year-old show hunter pony presented to the Large Animal Hospital at Tufts University School of Veterinary Medicine with a chronic history of hind limb lameness, unwillingness to move forward under saddle, bucking and refusing to jump. The pony had originally presented to Tufts five months earlier and was diagnosed with early osteoarthritis of the distal tarsal joints (bone spavin), which was treated at the time with intra-articular injection of long acting corticosteroids. In addition, radiographs of the dorsal spinous processes (DSPs) at that time revealed mild sclerotic changes and narrowing of the interspinous spaces, potentially resulting in “kissing spines.” We treated the affected spaces by injecting a combination of anti-inflammatories and analgesics. Despite treatment, the pony continued to become increasingly less willing to perform under saddle. On return to Tufts, the pony exhibited lameness of his right hind limb that was exacerbated following hind limb flexion. The degree of lameness was 1°- 2° out of 5° (0= sound, 5=non-weightbearing). Palpation of his back elicited a moderate painful response. Due to the chronicity of his clinical signs, we performed a nuclear scintigraphic (bone scan) evaluation of his hind end and back regions. The bone scan revealed moderate and diffuse evidence of radioisotope uptake (hot spot) throughout the dorsal most aspect of the DSPs at the level of the caudal thoracic-cranial lumbar spines. Additionally, there was moderate evidence of radioisotope uptake at the level of the distal tarsal joints bilaterally. Repeated radiographs of the DSPs showed further evidence of remodeling, narrowing and mild impingement of several processes, which, together with the scintigraphic findings, is compatible with “kissing spines.” Radiographs of the hocks revealed evidence of osteoarthritis at the level of the distal intertarsal and tarsal metatarsal joints, compatible with “bone spavin.” Sound Wave Therapy Not So Shocking Recently, a new therapy adapted from human medicine called extra-corporeal shock wave therapy (ESWT) has been used to treat a variety of equine musculoskeletal disorders. It has been granted approval by the FDA for treating heel spurs and tennis elbow in humans. A shock wave is a high amplitude acoustic (sound) wave. The mechanism by which it provides its therapeutic effects is not yet fully understood. However, initial studies have shown that it has a healing as well as short-term analgesic effect. The treatment can be performed on an outpatient basis under mild sedation. The standard protocol consists of a single treatment for bony conditions and a series of three treatments spaced three weeks apart for soft tissue injuries. Conditions most commonly treated at this time with ESWT include impingement of the DSPs, insertional desmopathies (high suspensory injury), bucked shins, maladaptive bone disease, navicular disease and ringbone. Based on the lack of clinical response following injection of the DSPs five months earlier, we decided to treat the pony’s affected area with high energy, focused ESWT. With the pony mildly sedated, we applied a total of 3,000 shocks (500 per site) to the affected region. Additionally, we injected a long acting corticosteroid (Depo-Medrol®; 80-100 mg/joint) to the distal intertarsal and tarsal metatarsal joints of both hocks. Following 10-14 days of stall rest with hand walking and restricted turn out in a small paddock, the pony gradually returned to full work under saddle (two weeks walk-trot before introducing cantering and avoiding sharp turns for four weeks). He returned to jumping one
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month afterwards. (We also placed him on a 14-day course of phenylbutazone. We recommended that his owner have the saddle professionally fitted and use a gel pad. We also suggested a course of acupuncture, but this was not performed. Follow-up communication with the owner five months later indicated that the pony was sound, performing well under tack with a significantly improved attitude, jumping, and able to be used successfully as a child’s show pony. This pony appeared to respond well to the combination of hock injections and one-time treatment with ESWT, whereas he had not done well with the combination of hock injection and back injection five months earlier. ESWT appears to have provided an additional, simple, noninvasive method of treating the pony’s performance by limiting his back pain.
Facts about “Kissing Spines” Impingement of the DSPs, better known as “kissing spines,” is a common condition that affects sport horses. It can be a primary issue or seen in conjunction with hind end lameness. Signs can range from mild reluctance to move forward under saddle to complete inability to perform. Factors that predispose horses to impingement include conformation, level of fitness, saddle fit and rider technique. Diagnosis is made by physical examination, thorough lameness evaluation, radiographic examination and most importantly, nuclear scintigraphy. Traditional medical management has consisted mainly of injection, acupuncture and proper saddle fitting. In some cases non-responsive to medical management, surgery consisting of the removal of every other affected dorsal spinous process has been shown to have very good success.
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