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Jan from Texas, writes:

Dear Dr. Dave,

My eight year-old mare is having lameness in her right rear fetlock. She has puffiness on the outside and back of that joint. She doesn't give me the rollbacks she used to, and her overall performance is slower.

My vet looked at it and after a few flex tests found nothing. Another vet told me he would inject her. I don't want to inject her without knowing what her problem is and what exactly "injecting" is and does. Do you have any suggestions?

Dear Jan,

Thank you for your question regarding your mare and her lameness. You maybe didn’t give me all the information I’d like, but I’ll do my best at giving you some possibilities.

“Wind puffs” are frequently seen on the rear fetlocks. Wind puffs are actually swellings of the fetlock joint capsule and usually the result of “wear and tear,” common in many using horses. However, wind puffs are typically felt and seen simultaneously on the outside and the inside (lateral and medial) aspects just above the fetlock between the flexor tendons and the cannon bone, and not on the back of the joint. However, I would want to rule out the possibility of wind puffs on your mare.

Rollbacks and barrel turns require a horse to really “power out” from the turns, and anything which could cause pain at the point of break over of the hoof will definitely cause an overall drop in performance.

From your physical description, I would be wondering about a “restricting annular ligament” just above the fetlock on your mare. This is a ligament that holds the tendons close to the leg during flexion and extension, much like the ligaments causing carpal-tunnel syndrome in people. The ligament doesn’t get smaller, but frequently the underlying tendon enlarges and thereby causes a “tightening” on the ligament.

This restriction and resulting pain can come on slowly, almost unnoticed, until performance is effected. If the tendon swelling is slight, sometimes just some NSAIDS, non steroidal anti-inflammatory drugs, and rest may be helpful. However, I have found that surgery is usually required to resolve the problem. Much like the surgery for carpal-tunnel syndrome, a simple cutting of the annular ligament usually results in return to athletic competition.

I encourage you to have your veterinarian ultrasound the fetlock, and possibly to do some diagnostic nerve blocks to local the affected structures. If a restricting annular ligament is found, I would recommend surgery at your earliest convenience. Waiting for self resolution in this case is rarely rewarding.

Congratulations on not wanting to subscribe to the “I don’t know what the problem is, but let’s inject it anyway!” philosophy. Injections can run the gamut of using steroids, antibiotics, anesthetics, and joint lubricants, and is too frequently used when a real diagnosis is missing.

Please feel welcome to contact me again if I can be of any help.

Happy trails,

Dr. Dave