Some Thoughts on Joint Injections from Dr. Tracey:
We see a lot of horses for performance issues and as a result we do a good number of joint injections for various problems. The following are some answers to frequently asked questions and some of my overriding thoughts about joint injections in general and some treatments in specific. As always, I recommend treating each horse as an individual and we are happy to evaluate your horse and discuss possible treatments for him or her at their appointment.
1. Be sure the right area is being treated. Allow your vet to do a full lameness work-up including flexion tests, nerve and/or joint blocks, radiographs (xrays) or ultrasound so that you can be sure you are treating the right area. There is no use paying for hock injections if your horse has a bad stifle or a strained suspensory ligament. That being said, there is a lot of grey area and sometimes response to treatment is the final piece to the puzzle.
2. Back in the day vets would tell us that steroid injections are bad for the joints. What they should have been saying is "indiscriminate" injections are bad for joints. We have more information now and it tells us that not all steroids are created equal and that they should be used accordingly. Some are bad for cartilage, some actually protect it, and decreasing inflammation is the healthiest thing for the joint long term (which is what steroids do). Hyaluronic acid is the other thing I sometimes add to joint injections. I call it the "icing on the cake" because it helps protect and lubricate the joint but doesn't have a lot of kick on its own. We also offer several Regenerative Medicine options that allow us to inject a joint with a potent anti-inflammatory without the use of steroids. These options include IRAP, PRP, and ProStride (the last being my treatment of choice for most joints with arthritis or other inflammatory issue).
3. Young horses get sore joints too. Some of it is probably genetically predisposed (possibly a result of the conformation we are breeding for). Do I want to go inject all the 2 year olds that are just going into work? No. Am I afraid to medicate a 4 year old that has sore hocks? No (unless he tries to kick my head in... then yes).
4. Once you start injecting you do not have to get your horse injected every 3 months for the rest of its life. In fact, please don't. Putting a needle into a joint carries the inherent risk of contaminating the joint even though we scrub and scrub and wear sterile gloves and blah blah. So if we can get away with once a year injections, that is awesome. Your horse will tell you when it's time. After all, you were the one astute enough to realize something wasn't right the first time around, right? So keep paying attention!
5. Joint injections are not the only option for sore joints. For older horses, sometimes the better answer is treating the whole body (they tend to be sore in more than one place, and they have certainly earned that right). This could be in the form of phenylbutazone (bute) or firocoxib (Equioxx or Previcox are two brand names) which are non steroidal anti-inflammatories (NSAIDs). Polysulfated glycosaminoglycan or hyaluronate sodium (Adequan or Legend) injections are also an option to help an older horse with sore joints. Given a choice I pick an injectable over a feed supplement for joints. I like Cosequin and Platinum Performance as much as any horsewoman but the fact is the horse's stomach is a tough place to be and I've just seen more effect from the injectable products.
6. If all that doesn't work there are certain joints that can be fused (or we can encourage them to fuse) without effecting the horse's ability to perform. The lower hock joints and the pastern joints are the ones I commonly work with in this respect. Horses need the rest of the high motion joints, but the lower hocks (distal intertarsal and tarsometatarsal) and pastern (proximal interphalangeal) joints are low motion and the biomechanics are (mostly) unaffected by their fusion. The technique I use involves alcohol injections to fuse (spot weld) hock joints to take the pain away. We can also do this in pastern joints. There are also surgical options for this stuff, usually more expensive but faster and more consistent results. I could talk about it for a long time and you would all get bored and wander off but the options are out there if you ever (heaven forbid) have a horse that gets to that point.