Diagnosis and Treatment of Stifle Lameness

The stifle is a frequent source of lameness in English and Western performance horses, although it's not as common a cause as the hock. Stifle problems arise from chronic, repetitive trauma, or as a result of a pre-existing condition. Rick Mitchell, DVM, of Fairfield Equine Associates in Connecticut, spoke about stifle lameness at the AAEP Focus meeting in Ft. Collins, Colo. on July 31, 2007.

A horse with stifle pain often reduces the anterior phase (as the leg reaches forward) of the stride and seems to move on its toes. Upper limb flexion tests elicit lameness on trot-out that typically lasts for a longer period than what is seen following flexion for hock pain. Effusion of the stifle joint(s) is sometimes present. Any other number of clinical signs might be demonstrated, including poor performance. The jumping horse might preferentially seek out one side of a jump, typically jumping away from the pain in a drifting fashion. He might swap leads while on course. And there could be recurrent gluteal or back pain in a stifle-sore horse.

Riding the horse might exacerbate the lameness, and it is helpful to observe the horse when the rider changes the posting diagonal at the trot. Canter cadence might be altered when the affected leg is on the outside of the circle. Common stifle conditions include osteochondritis dissecans (OCD) lesions; subchondral cysts in young, developing horses and in older horses with persistent bone microtrauma; upward fixation of the patella; meniscal damage; cruciate and anterior ligament damage; and chondromalacia (softening of the articular cartilage) due to chronic repetitive trauma. Radiographic views are essential to identify some of these conditions. Ultrasound is helpful to assess soft tissue and early bone responses.

Typical treatment of upward fixation is the use of anti-inflammatory medications (NSAIDs), hand walking followed by a conservative rehabilitation program, therapeutic shoeing, and sometimes an internal blister is necessary to manage a recurrent and persistent case. Whether you're dealing with a mild or more severe case, physical therapy exercise should include long periods of low-intensity work and hill work to strengthen the quadriceps muscles. Some practitioners have had success with intramuscular estrone (related to the estrogen estradiol) injections for its anabolic effect on increasing muscle tone, particularly in geldings. A surgical procedure of splitting of the medial patellar ligament might induce thickening and stretching of the ligament.

Management of stifle synovitis and arthritis is similar to therapies suggested for hock lameness--IA steroids, IA hyaluronic acid, systemic anti-inflammatory medications, systemic joint therapy, arthroscopy, shock wave therapy, and acupuncture.

About the Author

Nancy S. Loving, DVM

Nancy S. Loving, DVM, owns Loving Equine Clinic in Boulder, Colorado, and has a special interest in managing the care of sport horses. Her book, All Horse Systems Go, is a comprehensive veterinary care and conditioning resource in full color that covers all facets of horse care. She has also authored the books Go the Distance as a resource for endurance horse owners, Conformation and Performance, and First Aid for Horse and Rider in addition to many veterinary articles for both horse owner and professional audiences.

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