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By Chuck Maker, DVM
The patient was an 8 year old quarter horse reining mare. Milly pulled up acutely lame several weeks back in her left hind limb after the spring show and had developed significant swelling below the point of her right hock.
Upon an examination she was slightly toed out behind and had a mild sickle hocked conformation (see image of normal and sickle hocked conformation on the right). The trainer said she didn’t warm out of her lameness. While her degree of right hind lameness was initially only mild, this mare resented deep palpation of the swelling below her right hock and would become more lame with additional exercise. Hock flexion tests mildly increased her lameness for 5-6 strides. Physical exam demonstrated an enlarged back side of the hock with a thickened fibrous feel. Instillation of 25 cc local anesthetic into the area diminished her lameness considerably localizing the predominate source of pain to the back of the hock. Digital radiographs demonstrated degenerative changes to the distal 2 hock joints in both hind limbs consistent with her conformation and use. An ultrasonogram revealed thickening and structural changes to the long plantar ligament (PL) as compared to the opposite limb. We determined that Milly had Plantar Ligament Desmitis, or “curb”, a degenerative joint disease of both hocks.
"Curb" refers to any swelling at the back of the hock. Prognosis is directly affected by which tissues are involved in an injury and the degree of fiber disruption seen on ultrasound. Soft tissue structures located there include skin, subcutaneous connective tissue, deep and superficial digital flexor tendons and the plantar ligament.
As with many sport horse lameness cases, the most accurate diagnosis helps select the best treatment options for an injury. Doing so entails the use of diagnostic imaging to specifically identify the damaged tissue and measure the progress towards healing helping ensure the level of training is appropriate during the rehabilitative period. In this case, ultrasonography proved to be diagnostic and allowed us to chart her progress back toward soundness.
Milly’s injury was chronic and we initially treated her with nonsteroidal anti-inflammatory drugs, topical DMSO/corticosteroid Dex and an exercise regimen of rest with daily walking. Four (4) focal applications of shock wave therapy were done every 7-10 days over the ligament to insight new blood supply and recruit and reactivate cellular healing. Platelet rich plasma injections into the ligament were considered should the mare not respond to more conservative measures when measured at 5-6 weeks. Once ready for work her lower hock joints were injected routinely to further provide comfort in her training discipline. After 7 weeks, the mare resumed training and went on to show later in the fall.
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