XL Equine vet Nancy Homewood, from Hook Norton Veterinary Group deals with a horse named William showing signs of lameness and back pain.
William is a nine year-old show jumper, who had recently begun rearing under saddle. I had originally seen him at his yard, where I saw him being exercised in-hand and on the lunge. He showed signs of bilateral hindlimb lameness, but this switched between the left and right hind during the course of the examination. On the lunge William's hindlimb gait was stiff and he showed poor flexion through his hindlimb in the trot. He was also very heavy on the forehand in the canter, clearly trying to off load onto his front limbs.
On palpation of his back he showed pain from just behind his withers to his sacro-iliac joint. I checked his mouth for any sign of dental pathology that may be causing him to rear when tacked, but his teeth were in good condition. I referred William for gamma scintigraphy (‘bone-scan’) as I felt there was more than one reason for his back pain and hindlimb lameness. The bone scan showed increased uptake in his sacro-iliac joints and in one particular area of his dorsal spinous processes. So the next step after a bone scan is to anaesthetise the areas which show increased uptake to determine their significance, and then consider further imaging and treatment therapies.
William was exercised in-hand and on the lunge before I anaesthetised his sacro-iliac joints with local anaesthetic. His movement improved dramatically after having the area anaesthetised, so we elected to medicate the sacro-iliac joints with a long acting corticosteroid injection, to alleviate pain and inflammation from the joint and the surrounding structures. One inter-spinous space was also medicated, as this showed some re-modelling of the corresponding dorsal spinous process on radiographs.
William has been discharged to begin a programme of rehabilitation and physiotherapy to strengthen his hind limbs and back enabling him to carry himself better and not to be so heavy on the forehand. He's also having some shockwave therapy to help alleviate pain and improve circulation through his back and scare -iliac joint.
Cases of back pain can be primary or secondary to lameness, but more often than not the horse may have several underlying niggles that can contribute towards back pain. They are interesting cases to work on as focus needs to be made on diagnosing and treating the significant abnormalities within the horse.