Tuesdays with Tony – Joint Injections
This week I’m going to continue my foray into the athletic world. I figure once I’m on a roll, I may as well continue. This athletic thing is a fascinating topic I knew nothing about. Sleeping: now there’s a topic I am an expert on! Anyway, I have learned a ton watching Dr. Lacher and Dr. Vurgason work on these athletic horses. Lameness or poor performance seems to be a topic that comes up a lot. Personally, I think horses have not trained their humans well. No one talks about my “poor performance.”
Lameness appears to come in two categories as far as this cat can tell. There is the ‘trot them around and, yep, there it is on such and such leg’. Then there is the ‘my horse just isn’t doing right.’ This is also known as ADR (ain’t doin’ right). For the first kind the Docs perform nerve blocks to numb specific areas. Once the horse improves, they know the approximate area to look for the problem. Then they can pull out the x-rays and the ultrasounds to see what’s going on.
ADR lameness is more difficult. These will often require watching the horse perform under saddle. Sometimes, the lameness can only be seen when the horse is doing its job. I’m not sure what a job is, but it seems to involve work. A good video of the problem will often help the Docs out a lot. It seems some horses only have an issue if they are at something called a horse show. I have heard there is a similar problem with cars and mechanics.
All goes great, and the Docs are able to isolate a problem. Now what? Often the answer is an injection of an offending joint. What does that even mean? Never fear, I put my investigative hat on to find an answer. Turns out the answer is both simple and complicated all at the same time. There will be a serious nap after this blog. It has taxed my brain.
The simple part: a joint injection is injecting stuff into a joint. The complicated part: why and with what.
I assumed (you know what they say about assuming) that joints got injected because of arthritis. Turns out that is true in older horses. In younger horses, joints are injected to reduce inflammation from injuries and reduce soreness from training. It is very important to know why you are injecting a joint. If it is to help with an injury, then rest has to happen too. If it is soreness, it may be necessary to back down on the work for a few days. Arthritic horses can, and need to, go back to work as soon as possible. Why and what joint are very important for the future. Hocks can be injected for the competitive career of the horse. Every other joint that gets injected is at a cost to the long term health of that joint. Our Docs are always evaluating if that cost is worth it. For example, if the joint has inflammation that is harming the cartilage, then injecting it will cause less harm than leaving that inflammation in there.
Now for the what. Joints are usually injected with a combination of steroids, a lubricant, and some antibiotics. The steroid is chosen based on how much motion the joint does. For example, the fetlock does a whole lot of moving compared to the sacroiliac joint. Steroids are also chosen based on how friendly they are to cartilage, the lining of the joint, and any nearby important things like muscles. This means a different steroid is used in the stifle, than in the fetlock or the hock. The lubricant is almost always a high molecular weight hyaluronic acid. That is a fancy way of saying really gooey stuff. Sometimes the Docs will use Adequan, but that is reserved for the really bad joints. Last thing that goes in there is a bit of antibiotics. Joints do not handle bacteria well, so the antibiotics are there as a preventative. Our Docs are also super picky about scrubbing the area where the needle is going in to be sure it is really, really clean. Lastly, for those joints that are in really big trouble, our Docs go to what they call the “big guns.” These are called IRAP, PRP, and stem cells. They tell me these injections target the inflammation one step higher than steroids. They are pricey, but they do a very good job with minimal side effects.
Whew, that was a lot to say, and I only scratched the surface (pun intended). Joint injections are complicated and have a lot of factors involved. Want to know more? Ask away in the comments or check in with our Docs next time you see them. For now, I am off for a bite of food and a good nap. I haven’t had either for at least an hour.