To locate the source of the lameness

Joint injury Tendon or ligament injury Hoof pain Bone pain (fracture) Muscle pain Neurological disease (EPM) Mechanical

Excessive force and loading Stiffens bone- denser but less elastic From heavy work, hoof imbalances, poor

surfaces, Can be an accumulation of loading or a single

event Blunt or sharp trauma to the joint Infection Defects in the joint

Chips, fragments, OCD Poor conformation/deformities Poor cartilage structure

inflammation of the joint

Chronic inflammation will cause release of cytokines that degrade cartilage and collagen.

Cartilage becomes less able to absorb shock Continued exercise increases trauma to joint Synovial membrane scars and enlarges, fluid

amounts increase, viscosity decreases. Osteophytes form, subchondral bone loss

Subchondral bone sclerosis osteocyte death loss of blood supply microcracks in subchondral bone chips of bone at the edges cartilage and bone collapse

fracture

PAINPAIN

Pain comes from both inside the joint and outside the joint Intraarticular: synovial and cartilage

attachments Extraarticular: Increased pressure in the

marrow speculated as well as inflammatory cytokines or in ligaments surrounding the joint capsule.

Non medical therapies

Cold therapy 30 minutes for up to 72 hrs for acute injury

Liniments, poultice Limit motion- hand walk, limit turnout if

“new” keep in light regular exercise if “chronic”

Bandage to reduce swelling Corrective trimming/shoeing

Systemic medical therapies Adequan ® Legend®

Glucosamine HCL best glucosamine injectable N- Acetyl glucosamine less reliable in inhibiting degredation Glucosamine SO4 more easily incorporated but less stable

than HCl

NSAIDS Bute Banamine ®

Surpass cream ® topical Equioxx ®

Joint injections

SteroidsHyaluronic acid (HA)Adequan®®

Remove physical causes of inflammation Chip removal, OCD surgery. Infection- flush joint, antibiotics. Reduce exercise level.

Acupuncture Chiropractic Nutrition Herbal Homeopathy

Look for products that contain: Glucosamine HCL

5000mg per servingserving or lower amounts combined with chondroitin sulfate (e.g. Cosequin)

Best for minor/early lesions- decreases progression

Mixed reviews on success Takes 4-8 weeks for effect.

Chondroitin sulfate low MW better- Takes 2-4 months for effect, continued benefit after

discontinued. Decreases inflammation

Oral Hyaluronic acid MSM Omega 3 fatty acids (fish oil best) EPA

and DHA Enhance Animal Wellness

Combination Supplements Platinum performance ortho con series Cosequin ASU

Look for name brand products that have a history of quality products and good quality control Examples:

Cosequin Platinum performance Enhance animal wellness Michael Plumbs horse journal tests products

randomly for ingredient content and publishes the good and bad.

Shock Wave Unknown how it works Anecdotally helps with hock arthritis, navicular

pain

IRAP (Interleukin 1 receptor antagonist) Orthokine® made by Arthrex®

Made from horse’s serum. Inhibits IL-1 in people. May also stimulate anti-inflammatory interleukins

(IL-4, 10) and growth factors (FGF TGFβ). Successfully used in Europe in 30,000 patients

Used with horses with joints that do not respond to steroids

Potentially good for Cushing’s horses which can’t tolerate steroids.

Appears to be safe, non reactive, significantly improved lameness scores 5-8 weeks post injection (not tested beyond that date- may be longer.)

Can freeze serum for later use, and use in multiple joints.

Platelet Rich plasma (PRP) therapy Made from the horse’s own plasma. Platelets have growth factors stored in them

which are released when activated over a number of days.

Growth factors help speed tendon and ligament repair- helps joints by helping the supporting structures.

Used for difficult wound repairs Possible indication for navicular disease or

other bursal issues.

Stem cell therapyFat and bone marrow both have stem cells

and growth factors.

Fat- Vet Stem® system- great concept, recent study shows effectiveness.

Bone marrow aspirate- works well with ligaments

A Cell (ligament repair) A collagen scaffold material. Best for severe tendon ligament injuries Is reactive to tissues.

Grafts for bone cysts PRP+ bone scaffold Bone Marrow+ bone scaffold Cartilage grafts- promising Bone grafts- poor results

Joint fusionFor lower hock and pastern joints

Surgical fusion Laser

Chemical fusion MIA Alcohol

Foals need to have light exercise- encourages normal cartilage development in the first year of life.

Good shoeing and trimming practices distribute forces properly across the joint

Good nutrition Controlled growth of young horses don’t

overfeed. Balance of micronutrients including:

Copper, Zinc, Manganese, Selenium, monitor Su and Fe in water.

Use name brand Feeds- Nutrena ®, Purina

®, etc. Don’t mix and match supplements!

Legend®, Adequan®

Supplements- Cosequin ASU®, omega 3 FA (Enhance Animal Wellness ®) Platinum Performance

Good riding surface Regular exercise Good conditioning Don’t overstress joints too often

(tight circles, long rides etc). Help minor lamenesses before they

get worse

Ledgewood Equine Veterinary Clinic

David Trachtenberg, DVM

1o impact- vertical force• First collision of hoof with surface. Force gets

dissipated by joints.

2o impact – horizontal breaking• Increase in force second collision of body with

leg

Support • Most of second collision; puts maximal force on

limb

Breakover • decrease in force, strain applied in toe. Up to

2.5x body weight- most likely time that injury occurs.

Post Breakover- Tendon forces rotation of hoof/ joints