Dr. Hannah Mueller, DVM is a 2004 graduate of Oregon State University, College of Veterinary Medicine. She strives to provide the best care possible for her patients and believes her unique holistic approach allows her to do so. Dr. Hannah has a solid foundation in sports medicine and lameness. This, along with her training in acupuncture, chiropractic, stretch exercises, massage techniques and other hands on healing modalities, allows her to rehabilitate horses to their fullest potential. Cedarbrookvet.com
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Q: My horse appears to have injured something in her shoulder (we’ve ruled out anything lower in the leg). We’re not sure how, as there are no marks or swelling, just abnormal movement and lameness. It appears to be soft tissue. My vet is not equipped to do further diagnostics as the shoulder is such a large area. What would be your next step?
The shoulder area is a difficult and expensive area to definitively diagnose, so a treatment plan is often based off a tentative diagnosis, or a diagnosis of rule-out. If you have ruled out the lower leg, then I can assume flexion tests and nerve blocks have been done up to the level of the carpus (knee). The carpus can be ruled out with a flexion test and joint block; however, blocking the joint (ie going into the joint with a needle and lidocaine, not blocking a nerve) is fairly invasive. In some cases, we will do x-rays (+/- ultrasound) to determine if a joint block is warranted.
Assuming the carpus has also been ruled out, you have worked the lameness up to the forearm, elbow, shoulder and scapula region. There is a lot you can determine by palpating this region, and it sounds like your vet suspects the shoulder. As a veterinary chiropractor, I regularly and thoroughly evaluate this region and can pinpoint problem areas based on a pain response to palpation or restricted range of motion. I would need to do my own palpation to give you a treatment plan, but I can give you some general ideas here.
There are techniques available for taking x-rays of elbows and shoulders, but they are difficult and understandably outside of the scope of some equine practitioners. At this point, your choice is to treat the proximal limb based on palpation and rule-out, or go for more diagnostics. In making this decision, you need to factor in your budget and the stress of further diagnostics on your horse. If the workup so far has been relatively low stress for your horse, and further diagnostics are in the budget, then go for it. I always want to know what I’m dealing with before making a treatment plan. A bone scan (nuclear scintigraphy) is a good place to start for lameness that is difficult to localize, and x-rays can be taken based on the results.
For sake of discussion, let’s assume a bone scan is not in your budget and you choose to treat the area without a definitive diagnosis (some people choose to start with this, and then if progress is not being made, go for further diagnostics). I would start with a series of chiropractic adjustments and acupuncture/ SCENAR treatments (check out my website for more information on SCENAR therapy). Often, these treatments can help pinpoint the problem area and get you closer to a diagnosis, and help determine when it is safe to go back to riding.
Based on the treatment and your budget, a treatment interval will be determined. A rest program should also be initiated depending on the degree of lameness. Stall rest with controlled hand walking is ideal if your horse is quiet in the stall; if s/he isn’t, you will need to determine what type of living space will keep your horse as still as possible (walking slowly/quietly with minimal circling, trotting, or high impact maneuvers). Some horses do best in a small outdoor paddock with a run-in stall next to or with a quiet buddy, while others need herbal calmers in any situation. A hand walking program will be set up, with the frequency and duration depending on the degree of lameness and rate of progress. Your homework will likely be a series of leg stretches after the walk warm-up.
In addition to bodywork, anti-inflammatories are often used in shoulder injuries. Depending on the severity, you would use an herbal product (such as Ani-Motion from Equilite) or a NSAID drug such as Bute or Equioxx. In some cases, steroids (or other medications including hyaluronic acid) are injected directly into the joint or bursa to bring down acute inflammation. However, they should be used sparingly over the long term and a definitive diagnosis should be obtained prior to this treatment. Ice packs and cold hosing can also be used to decrease inflammation. If there was swelling, I would use a topical poultice such as Dynamite Miracle Clay. Other topical treatments to consider would be Surpass (a topical NSAID) or Traumeel (a homeopathic cream for acute and chronic trauma).
Any time there is an injury involving a joint, supplements are important. I would consider putting your horse on Cosequin ASU (glucosamine, chondroitin, MSM) and starting an Adequan loading dose. This gives the joint the best chance of complete recovery without the later development of arthritis as a result of the initial injury.
A re-check lameness exam should be performed before your horse is released into a controlled conditioning program and then started back into regular turnout and work. Progress can also be monitored with quarterly chiropractic and acupuncture treatments.
With treatment, most moderate shoulder injuries take two to three months to recover from, but it can vary greatly depending on the horse and the injury. Without treatment, shoulder injuries are more likely to become chronic, and lifelong lameness can result.
Q: Can horses get concussions?
Yes, horses can get concussions from head trauma. Knowing what commonly leads to head injuries, and preventing them from happening in the first place, is key. I have seen a number of these injuries occur when horses pull back while tied and break the halter or rope. The horse then rears up, flips over backwards, and hits their head because of the pullback momentum. These injuries can be avoided if you always use a blocker tie ring or something similar that prevents the horse from breaking a halter/rope.
Trailering injuries are also common. Use the blocker tie ring in the trailer and never tie a horse even to a blocker ring until the doors/butt rope are secured. This prevents them from trying to back out of the trailer while tied, causing them to rear up and injure their head. The use of a head bumper is of utmost importance, even when trailering a “been there, done that” horse.
Lunging with side reins and dealing with behavioral/training issues on the lunge line or under saddle are other common culprits for rearing/flipping-induced head injuries. Avoid the use of fixed side reins, especially in a green horse or a rearer, and work with a trainer who can help you anticipate and avoid rearing behaviors.
With this said, injuries can happen even in the best of situations, and when they do, it is an emergency situation that most likely requires veterinary intervention. Symptoms of a concussion include confusion, poor coordination, dullness/ depression, bleeding from the nose or ears, circling, blindness, convulsions, or even death. Treatment is aimed at decreasing brain swelling (steroids, diuretics) and providing supportive care to allow time to heal.