Help - 16 day old filly partially paralysed.

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Danielle_E.

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Is there any way she could have injured her back at all? I find it strange that it is both back legs at the same time. For some reason I am thinking something to do with the spine or something like that? I sure hope you find out soon! HUGS.
 

Danielle_E.

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The only other thing that comes to mind is perhaps she ingested something that is causing a paralysis. I understand if a horse eat Larkspur it can cause such problems. The only other thing I could possibly think of is whatever it is might be something that was transmitted by a bitting bug, such as a mosquitoe.
 

Marty

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OH Bec, I have no idea what is going on with your beautiful baby. I've been researching for a couple of days now and it's just so conflicting and confusing. It can be anything.

I know I don't have the right here to be suggesting a thing, but I am just going to through out at you that maybe this horse should be put on something for anti-inflamatory just to see what happens.

I found this article here for you and I will continue to research and see if I can come up with anything else that makes sense.

Love you Bec. I'm really sorry this is happening to you.

Advanced Reproduction Short Course 2000

Joint Ill

Lecture Notes

Imogen Johns

INTRODUCTION

Joint ill is a real problem on stud farms and for the smaller breeder- it has an estimated prevalence of 0.5-1 % in Thoroughbreds. It can result in loss of the foal for future athletic performance, and in the most serious cases, euthanasia may be the end result.

DEFINITION

Joint ill is an infection of the joint +/- adjacent bone, caused by a variety of bacteria. The term ‘ joint ill ‘ is thus somewhat misleading, because the infection can, and often does, spread to the bones on either side of the joint, resulting in an osteomyelitis - an infection of the bone. Most commonly, more than one joint is involved

ANATOMY

To understand how we go about diagnosing, treating and preventing joint ill, it is useful to know a bit about the anatomy of a joint. A joint is the union between two or more bones. It is surrounded by a fibrous joint capsule, and filled with lubricating joint or synovial fluid. The bone ends which make up the joint are lined by a special type of cartilage called articular cartilage. There are thus different types of joint ill which are classified according to which areas of the joint are infected . In the most simple type, there is no involvement of the bone, and there is usually a better response to treatment, but if the bones of the joint do become involved, then treatment becomes more difficult, and the prognosis for a return to normal becomes more guarded.

PREDISPOSING FACTORS

Joint ill is most commonly preceded by septicaemia - a systemic bacterial infection. The sources of the bacteria include the genital tract of the mare, the skin of normal horses , and the environment. These organisms gain access to the blood stream by a variety of routes, including the respiratory tract, the gastro-intestinal tract, the umbilicus and the placenta. The bacteria then enter the joint, establishing a focus of infection.

Failure to acquire sufficient colostral immunity is probably the leading contributory cause of neonatal infection. Other factors which predispose to the development of septicaemia, and thus joint ill, include

environmental factors eg overcrowding, poor ventilation, poor sanitation,

inappropriate umbilical disinfection -this can be not only insufficient disinfection, but also being overzealous with your disinfecting agent, and 'burning' the foal,

problems with the mare eg infections of the placenta,

difficulty foaling other foal problems eg prematurity,

So you can see by these factors which increase the likelihood of joint ill occurring that there are several management strategies that can be implemented to decrease the likelihood of joint ill occurring.

DIAGNOSIS

" A lame foal has joint ill until proven otherwise "

Lameness

Joint ill is one of the most common cause of lameness in foals. Other causes include fractures , kicks, bruises to the foot, developmental abnormalities eg tarsal collapse, contracted tendons. While foals with joint ill are commonly systemically unwell, this is not always the case, and the disease should be suspected in any lame foal.

The degree of lameness can vary. It ranges from very subtle - just not moving quite right, or stepping short, to non weight bearing fracture lame. While the foals that are very lame may be easy to diagnose, those with subtle lameness's can be more difficult. Foals that are unable to stand, either because they are too weak, systemically unwell or have angular limb deformities, will not , however, be recognised with a lameness.

So lameness is often the first recognised sign. In addition, infected joints can become hot , painful and swollen and the tissues around the joint can also be swollen, indicating the infection is present in the bone. All foals, especially those at increased risk, should routinely be monitored for signs

of disease. Palpation of the joints and monitoring of rectal temps are important so that an early diagnosis and initiation of treatment can be instigated. An increase in rectal temperature does not always occur with joint ill, and indeed the foals temperature can be sub-normal. However, an elevated temperature is a good indication of infection, and is thus a useful tool for diagnosis

Joint Fluid Examination

If there is a suspicion that a foal does have joint ill, a sample of joint fluid should be taken, preferably before antibiotics have been started. However, if there is a delay in sampling, antibiotics should be started regardless. Analysis of the joint fluid can aid in diagnosis, and also treatment options. Normal joint fluid is clear, with low cell and protein levels. Gross examination of the sampled joint fluid is sometimes diagnostic - ‘pus ‘ = infection. Further analysis includes protein and cell levels, which are elevated in infection. Culture and sensitivity ( c and s ) can also be performed. The purpose of culturing joint fluid is to identify the bacteria causing the infection and then find the antibiotic that would be most effective for treatment. While c and s is often helpful in the treatment of joint ill, it is not the be all and end all for diagnosis, as the results take several days , and a negative culture i.e. no bacteria grown, does not rule out infection. Previous antibiotic treatment, sampling methods, and the low number of bacteria which can be present in the joint can all result in a negative result, as can infections of the adjacent bone, with no spread of the bacteria to the joint.

Blood Samples

Blood samples can also be helpful in the diagnosis of joint ill. Blood can be cultured to identify a septicaemia. An increased white cell count may occur, and indicates infection. Packed cell volume and protein levels can help in the assessment of dehydration, and Ig should be measured to check for Failure of Passive Transfer.

Radiographs

X rays are useful not only for initial diagnosis, but also for monitoring the progression of the disease and the effectiveness of treatment. They can also be used initially out rule out a fracture, and to identify any accompanying osteomyelitis, if present. Initial rads are also useful to provide a baseline for further x rays eg if no bony involvement is evident initially, but response to treatment is slow, then follow up rads may subsequently show osteomyelitis. Radiographic examination can be helpful in assessing a foals prognosis - a foal with multiple joint involvement and evidence of osteomyelitis on rads has a poor prognosis for use as a performance animal.

TREATMENT

Treatment of choice depends on how early treatment is initiated, the number of joints involved, whether bone involvement is suspected / confirmed, and the severity of the disease.

Antibiotics

Antibiotics should be started as soon as joint ill is suspected, but preferably after joint and blood samples have been taken for culture.. A wide range of bacteria, including Salmonella, E coli and Actinobacillus equuli are commonly found in infected joints, and thus initial antibiotic is ‘ broad spectrum ‘ i.e. effective against a wide range of bacteria which can cause the disease for eg penicillin and gentamicin. When and if culture results become available, the antibiotic regime can be altered accordingly. Foals should be kept on antibiotics for at least three weeks after clinical signs eg lameness, joint swelling, have stopped.

Assess foal’s status

Many foals with joint ill are also systemically unwell. It is important to fully evaluate the foal clinically, especially to look for other sites of infection eg scan the umbilicus. The foal may be dehydrated, need IV fluids, helped to nurse or stomach tubed with milk to maintain nutrition and hydration. If the foal has a history of FPT then colostrum or plasma may be indicated.

Drainage

The aim of draining affected joints is to remove debris and inflammatory mediators which can potentiate and prolong the infection. If the disease is caught early, and antibiotics started, joint aspiration, by removing joint fluid with a needle, may be sufficient. However, if the disease has been present for more than 24-48 hrs, or the foal has not responded to joint aspiration, then more aggressive therapy is warranted.

Distension-irrigation and through and through lavage are two techniques which can be used to more completely drain and flush the joints. Both require the foal to undergo GA, and the number of treatments depend on the foal’s response to each treatment.

The use of arthroscopy where you put a camera into the joint to drain joints and evaluate cartilage damage is becoming more popular. Open drainage can also be used.

Exercise Restriction

The foal must be box rested for a significant amount of time, to minimize the potential damage of excessive weight bearing on inflamed joints. Some foals are bandaged or put in casts to restrict movement

Nursing

Good nursing is critical for a successful outcome. Foals need to be kept warm, hydrated and with attention to nutritional needs - hand feeding, IV fluids if necessary. Regular monitoring of the foal’s clinical status eg rectal temp, palpation of joints, follow up radiographs and bloods can help in the assessment of response to treatment .

Other

Non steroidal anti-inflammatories eg finadyne are important both for their anti-inflammatory effects and also for pain relief. Sometimes these foals are so painful that they wont feed, so its important that we make them more comfortable.

Anti-ulcer medication can be important

PROGNOSIS

Improves with prompt recognition and aggressive treatment . Foals that respond quickly to treatment have a better prognosis . Foals with several joints involved can be a nightmare to treat, and often are euthanised.

PREVENTION

Farm management

Farm management is the key to preventing joint ill, and because it can be such a difficult disease to treat, prevention is certainly better than cure. It is important to rotate and rest foaling paddocks and yards, so that contamination eg faecal is kept to a minimum, thus minimizing the potential for foals to become infected by environmental bacteria. Preventing overcrowding by reducing the stocking rate will also help decrease environmental contamination. Good ventilation and sanitation in foaling boxes is important.

Foal monitoring

Ideally foals should be monitored to ensure that they have sufficient intake of colostrum within the first 6-12 hours. Foals should also be checked regularly after this so that early signs of septicaemia and joint ill can be detected, and treatment initiated sooner rather than later.

Antibiotics

Antibiotics can be used to prevent infection, although their routine use is debatable. Situations where they may be warranted include in the face of an outbreak, or where there is limited personnel to monitor foals.

Knowledge

Knowledge of foals at increased risk of developing joint ill can aid in early recognition, diagnosis and treatment. Foal watchers who know what to look for are invaluable, because the earlier the disease is recognised, the better the outcome.
 

Robin1

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Sorry to say, I hope I"m wrong, but after looking at the pictures I think it is an spinal injury. It is the third picture that really makes me think this. Yes, her foot is pulled up for her to stand on however she is standing on the top of her foot not the bottom. I had a cat that was hit by a car several years ago that was paralyged in the front leg. The vet wanted to put him down but I took him home. Every day I would do different motions with his leg and eventually he recovered much to the disbelief of my vet.

The next time you are out with your baby, pinch different areas of her leg and see if she tries to pull away. Just because she pulls away if you pinch up high, keep going down. Although my cat would react to pinching up higher he would drag his leg and the lack of feeling was much lower in the leg.

I hope all goes well and your baby recovers with no side effects.

Robin
 

ChrystalPaths

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I will jump in again. I also believe this is an inury. Having spinal injuries myself I can empathize, but she has little or no pain so that in itself worries me. Could you maybe kinda sorta ask if she could have an MRI? THAT would show everything. Was it Dona that had one done or Lauralee? last year? It would be costly but you'd know definitively and she's so lovely, it would be a shame for her to further injure herself. Best of luck, I'm praying for her. (Perhaps you could chat with Bonnie? So worth the $$)
 

Lauralee

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Sorry it wasn't me that had the mri done...but I remember the pictures!

I think Beccy posted somewhere that the filly DOES react to a needle test on her hindquarters, meaning she CAN feel her rear end.
 
K

kaykay

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sure looks like upward fixation of the patella. Ive just never seen it this bad especially in one so young. Shes had a tetnus shot right?? I did hear once of a foal getting paralzyed by getting a shot in the wrong place in the hip??
 

Marty

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Upward fixation of the patella: treatment by ligament splitting.

Upward fixation of the patella is a common condition of the stifle joint. It occurs when the medial patellar ligament hooks over the upper end of the medial trochlea of the femur (one of the two the bony ridges on which the patella slides).

In the most severe cases the patella becomes fixed and the horse is unable to flex the leg. The horse stands with the affected hind leg extended behind it. Less severe cases show partial, intermittent upward fixation, which produces visible, and sometimes audible, clicking as the patella frees itself.

The condition is most common in younger horses, and is often associated with poor muscle conditioning. Horses with straight hind limb conformation are more susceptible than horses with normal conformation. Both hind legs may be affected to some extent. When upward fixation of the patella occurs, the ligament stretches making a recurrence of the condition likely.

In less serious cases increased exercise, to improve muscle tone, may be all that is required to reduce recurrence of the condition. However, persistent cases may require surgical intervention.

For many years the recommended treatment involved cutting the medial patellar ligament ("medial patellar desmotomy"). Although this is effective at preventing the patella becoming fixed, recent work has shown that it is not without adverse effects. Fragmentation of the patella occurs after the operation in a significant number of cases.

Now a new technique has been developed which is effective and does not appear to be associated with side effects. Dr Aziz Tnibar, working in France at the Equine Clinic of the Veterinary School of Alfort, has devised a procedure in which the upper third of the medial patellar ligament is split.

The horse is anaesthetised for the procedure. Dr Tnibar uses ultrasound guidance to ensure the correct placing of the cuts, making sure that they do not extend into the femoro-patella joint or into the fibrocartilage extension of the patella

The aim of the operation is to cause thickening in the ligament to prevent it becoming hooked over the end of the femur.

"The rationale for percutaneous splitting of the upper third of the medial patellar ligament is to induce a localized desmitis, which subsequently leads to a localised thickening of the ligament. This will make it more difficult for the upper part of the ligament to hook over the medial ridge of the femoral trochlea" says Dr Tnibar.

Dr Tnibar has now performed this operation on seven horses and ponies. All seven were affected with upward fixation of the patella in both back legs. After medial patellar ligament splitting, all seven became sound and returned to work. In three horses the upward fixation of the patella resolved completely within 24 hours. In the other four cases, the condition resolved within 24 hours in one leg. The other leg improved gradually over a period of 4 - 12 days.

Dr Tnibar recommends daily light exercise (walking in hand for 15 minutes three times day) for 2 weeks after surgery. Normal activity is gradually introduced after two weeks.

Follow-up examinations show that the upper third of the medial patellar ligament becomes thickened. There is a progressive increase in medial patellar ligament size during the first four weeks after surgery. Radiographic examinations have not shown any sign of damage. In particular, no horses have developed fragmentation of the patella .

Dr Tnibar concludes that this is a successful technique for the treatment of upward fixation of the patella. "In each case all evidence of upward fixation of the patella has disappeared, and the horse (or pony) has regained its normal activity".

....................

For more details see: M Aziz Tnibar Medial patellar ligament splitting for the treatment of upward fixation of the patella in the horse.Proc Am Assoc Equine Pract (2001) 47, 491 - 493
 

sgambuti

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Hi,

I read your problem with much interest as I have a 2 month old colt with rear leg problems. From birth he seemed a little weak in the rear legs but gained strength and was doing well. About 2 weeks ago he appeared to have lost all coordination and strength in his rear legs. I was convinced it was stifles but was not totally sure, so I called in a chiropractor. Turns out he had 2 vertabras and his pelvis were misaligned, probably since birth in his case, the chiropractor adjusted him, performed accupressure on him and said that he would be sore for 2 days then he should start to feel better.

Just as the chiropractror predicted, by the third day he was running and kicking and rearing, when he attempted a rear with a buck, he fell to his rump. He appeared to be back at day one, this Saturday the chiropractor arrived, realigned him and he seems much better. The chiropractor said that he was not as misaligned this time around and he felt that barring anymore "accidents" he will be fine.

Perhaps you could try this, it seems to be working for me and my colt.

Sandy
 

Beccy

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Oh my, after a hectic day of work, trying to get one of the kids off to camp, and also trying to connect with the vet who had one emergency after another today, this is the first break I have had.

Marty thanks so much for looking up all that stuff, I have read the stuff posted here but haven't checked out the link yet. Will do so shortly.

After considering all things, and consulting with a vet at the University of Guelph, our vet is now thinking that it is the stifles.

He has ruled out a number of things, including a spinal injury, as she has lots of feeling in her hind end (reacts to pain) and her tail is "going like an outboard motor" in his words. This was my main fear especially given her habit of rolling and getting stuck.

He says they suspect a patella luxation, as opposed to a fixation, and I do not understand the difference.

Cherokee has an appointment at the clinic first thing tomorrow for X rays, and if this confirms it, he will decide then how to proceed.

Have all sorts of questions now...

How is a luxation different from a fixtion, how serious is it, and how difficult is it to treat?

Is this very uncommon in a foal so young, especially both legs?

Is this genetic, or could it be caused by something else? Neither the dam nor sire have ever had any problem with their stifles, and neither has produced a foal with the problem, including the filly's full brother.

For now Cherokee still seems quite unconcerned, she is such a sweetheart. Just praying that the outcome will be good, and that whatever has to be done, it can be done soon!

Thank you so much to all of you for your input, and Sandy I am glad your colt is doing well!
 

Mona

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I have not had any experience with it in horses Beccy, but have had in dogs. Molly had it severe in one hind leg, and to a lerrer degree in the other. She would be walking and it would pop out, and lock up, and her leg would be right out behind her. I would have to manually pop it back in for her. She had surgery at under 1 year of age.
 

Lauralee

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Hi Beccy,

Stifles can either be too tight or too loose. It sounds like your foals' are too loose.

By sheer medical definition, LUXATION means dislocated, or not in place.

FIXATION would mean unable to move, or locked into place.

There is a surgical solution for your foal in either case so don't give up hope.

Lauralee
 

Beccy

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Thanks Mona and Lauralee, I am breathing a sigh of relief here, though I don't want to tempt fate by assuming all is going to be fine.

If fixation means stuck in one position, wouldn't it be a fixation rather than a luxation then? (perahaps I misunderstood something in the conversation, our vet is Dutch) These legs are stuck in this position, they are not popping in and out. We tried the suggestion that a couple of people made to try backing her and she just sat down. If it wasn't serious it would have been comical. The other suggestion that a friend had made, was to tap her hind legs between her butt and the hocks to see if they would unlock even momentarily, and they didn't, and she was mad at us for that! She is a corker this little girl!
hope this will weigh in her favour!
 

Lauralee

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Hi Beccy

I can't explain why your vet told you what he did.

But I do know the medical definition of luxation.

Either way at least you know in general what is wrong with your little one and hopefully you'll be able to find a cure for her.
 

Minimor

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Hi Beccy;

I hunted up my vet book--According to Equine Research, a dislocation of the stifle joint is called a "luxation". It says the condition is rare because of the strong ligaments that support the stifle joint. This condition nearly always involves tearing or stretching of the ligaments...there's actually a full page on this condition, too much to write here just now. It does say it's important that it be treated as soon as the injury (note this is all in reference to an injury, it makes no note of it being at all common in new/young foals) is discovered, to prevent the joint capsule from filling with connective tissue.

The thing is, according to this, luxation results in a deformed leg--and the horse is lame. It does say a dislocation may fix in a certain position. Treatment consists of putting the joint back into normal position, and recovery will not be complete or quick. With sufficient rest, a return to near normal is possible.

Now, this book also mentions that in cases of upward fixation of the patella (locked stifle) the stifle and hock joint is locked in a fully xtended position, unable to flex. The digital joints, however, will be able to flex, so the fetlock and front of the foot rest on the ground--the description and pictures look just like your filly.
 

Miniv

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I have to admit I've sort of skimmed a lot of posts, but after seeing the photos of your beautiful filly, I am wondering if you've considered an Equine Chiropractor????

I do feel it was probably an injury.....

Please keep us informed. She is a lovely baby!

MA
 

Beccy

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Miniv, I wish treatment such as this were available in our area, but it is not. Much further south, in race horse country, there is all sorts available, but keeping doctors of any sort, animal or human, up north here is difficult, which is why we sometimes can not get a vet right away if ours is on vacation or his weekend off. Not even an equine dentist! I heard there is one, who is actually from the States, who comes up to this area once a year.

Holly thanks for the info, I hope that the outcome will at least enable her to live comfortably.
 

Miniv

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Oh Lord......that's frustrating......

If you can't get some 'hands on" work done, please call Bonnie and schedule something. I personally don't have the ability that she does, but I know that she may be able to help in some way. (I only do a limited amount of hands on.) She can also tell you where you should be focussing your efforts.

Sending you all the best for your beautiful girl,

MA

PS. If you call Bonnie, it is $45 well worth it!!!!!!!!
 

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