Question: I just found out my functionally sound OTTB had pins for a hairline condylar fracture during her racing days some eight years ago. Some mild arthritic changes showed up on a recent x-ray, which also explains why she can be uncomfortable working on a shifting surface like sand. What are some best ways to help her moving forward from here (i.e. boots, supplements, types of work surfaces, etc.)?
Answer: Condylar fractures are the number one fracture affecting TB racehorses, most commonly it will be the left front lateral condyle affected. Because this area involves the joint surface of the fetlock, these injuries can lead to the development of arthritis down the road. Fetlock injuries and arthritis can be challenging to manage because the fetlock is a complicated high motion joint, it is subjected to a tremendous amount of stress because of the forces exerted on the joint during movement.
It sounds like you already have radiographs of that limb so perhaps a lameness has already been worked up. If you have not had the lameness localized, I would recommend that as the first step. If not already completed, you can have your veterinarian localize the lameness through flexion tests, joint and regional nerve blocks and imaging studies such as ultrasound/MRI/CT (example – ultrasound examination of the many soft tissue structures in the fetlock region). It is possible that the arthritic changes in the fetlock are not the primary source of pain.
Assuming that the fetlock arthritis is the source of pain you have a few options for management. You can have your veterinarian inject her fetlock with Hyaluronic Acid with or without steroids as he/she prefers, some clinicians like Glycosaminoglycans intra-articularly also. You can inject the joint with IRAP or Pro-Stride (made from your horses own blood) which utilize the bodies own anti-inflammatory mediators to quiet down inflammation – these are a good option for long term management. There is some indication that Stem Cells or PRP (platelet rich plasma) may also be beneficial. Shoeing should be balanced with plenty of support, short toes and easy break over. There are some good options for therapeutic shoes available now. Denoix shoes by Grand Circuit are specific for decreasing strain on certain areas of the limb and might be something to investigate. Radiographs to monitor shoeing balance a few times a year are helpful.
You can utilize hot and cold therapy as needed. When it is chilly outside, and she gets stiff, you can apply heat over that joint while you get her tacked up for work. This will increase blood flow and loosen her up. Similarly, you can apply 10” of ice or cold hosing after work to help decrease inflammation in the joint. There are topical products you can use to hep control pain and inflammation. Examples are: Surpass, Arnica gel, Traumeel gel or Sore No More. Not all of these are USEF legal. Acupuncture can be helpful for long term management of arthritic pain and is another option to consider. There is some evidence to back the regular use of intramuscular injections of either polysulfated glycosaminoglycans, pentosan polysulfate and/or intravenous hyaluronic acid in the management of arthritis. Of course, you can always utilize NSADs (phenylbutazone, banamine or firocoxib) as needed to manage pain and inflammation.
For oral supplementation, look for joint supplements (chondroitin sulfate, glucosamine) that are backed by research. The manufacturers of these products will usually publish the independent research on their websites. I have had good results using Cosequin ASU, but there are many other options. I have had good success with adding in MSM, Boswellia, Fatty Acids (chia seed or flax seed) and antioxidants to the daily diet in addition to a joint supplement. Make sure to use reputable manufactures for supplements.
Fitness is important for joint stability. Try to work to minimize strain on that fetlock, lots of straight lines, minimize small circles to that side etc. Work her on even ground with footing that is not too deep or too hard. Avoid uneven footing, this is very important to decrease the chances of straining the fetlock. You can use a fetlock support boot during work and ice boots or hosing after work. If she has had a hard day consider adding standing leg wraps after she is worked. All the best to you and your mare!
Courtesy of AAEP
Answered by Terri Van Wambeke, DVM, Oregon City, Oregon