# Cortisone hock injections for an eventer - good or bad?



## melv1lle (16 September 2008)

Hi.  I have an ex steeplechaser (11 yrs old) who I have started eventing.  He has always been stiff on his left side and 1/10th lame in his left hind and so now that I am competing I took him to the vets for a full lameness check.  The vet identified that he has low grade arthritis in both hocks and has suggested we start cortisone injections (I believe with HA in as well).  So my question is do people think they are a good idea?  I had assumed they were some kind of wonder drug (backed up by many of my livery friends) that could only do good but I have started reading on the internet that some people think they do long term damage (although no one seems very specific why).  So people's thoughts - are they good or bad


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## ColouredFan (16 September 2008)

I've had a cortisone injection in my shoulder well two actually, they improved symptoms for a couple of months but then went back to how it was before, Docs wont inject again and now goingdown the route of surgery.

My nan had cortisone inection in her elbow and it cured her completly, so not sure if I would recommend or not, sorry!


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## lucretia (16 September 2008)

thats sort of how it works in horses too, once you start you have to keep on doing them and in my experience the interabls becomes shorter and shorter and the benifits less and less. i would have to say looking at the horses over the last ten years that i have had that have had this treatment (and remember i have lived in canada and the states where this is almost routine for jumpers) that IMO the horses working life is not prolonged to any significant degree and often leads to other problems.


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## ihatework (16 September 2008)

Personally I would do it at least once, some respond very well to them with no complications, if you find they need doing every 3-4 mon ths then I probably wouldn't continue, but annually I would.
I'd also look into adequan IM


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## melv1lle (16 September 2008)

Is Adequen IM a food supplement?  The vet gave me a large tub of something as well but I have to admit I didn't look at the label


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## Bossanova (16 September 2008)

In my experience, cortisone rarely helps enough to get the horse back totally sound through competition for any length of time.


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## lucretia (16 September 2008)

and also (prepares to be shot down in flames) i would put the horses on a glucosamine supplement if not already (remebering that it is a product where you get what you pay for) cos it helps me (very stiff and battered after major accident in past) and made a NOTICABLE difference to horses living in london and permenantly stabled which is a big recommendation in my eyes.


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## Darkly_Dreaming_Dex (16 September 2008)

Adequan is a short course of intra-muscular injections and i have used it on both of our arthritic horses with good results but it is pricy around £250 for the course (thanks AIMS 
	
	
		
		
	


	




)with vets callout on top if your OH cant do the jabs for you 
	
	
		
		
	


	




A PURE glucosamine supplement is very good too- thats probably what your tub is.


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## lucretia (16 September 2008)

yeah check the label on the tub there are alot of generic versions which dont do a great deal.


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## melv1lle (16 September 2008)

He was on Cortaflex but this will be replaced by the vet's stuff (which only comes from the vet) so I would guess it probably is the higher concentrate glucosamine.


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## seabiscuit (16 September 2008)

Cortisone injecs are pretty much a waste of time/money- they are the vets most favourite way of making lots of money out of you!

Deffo reccomend a good joint supplement and also looking at the shoeing ( making sure that the toes are short and that there is good heel support)


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## melv1lle (16 September 2008)

Its not the shoeing - he was a steeplechaser for years and so its just a result of years of pounding around a racetrack (amazing really that there is nothing else wrong).

I am surprised though that everyone has had such limited success with the injections though.  Three or four of the people on my yard use them on their horses and they said the effect was incredible.  Perhaps I will just try it once or twice and if no success will think of a plan B.


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## melv1lle (16 September 2008)

Forgot to say - I live in London but horse doesn't.  He lives in a much nicer part of the world outside of the M25  
	
	
		
		
	


	




 and so is out all night so he isnt stuck in a stable or anything like some of the poor urban horses.


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## ihatework (16 September 2008)

I have seen it used to good effect on many a horse, however I wouldn't want to get into the cycle of repeat injections.
When the arthritic changes are minor it really can help. 
I would most certainly do at least one set of injections if he were mine, combined with adequan and it goes without saying a decent joint suppliment.
O_B does have a point though about shoeing,  ask your vet if there is any changes he could recommend


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## melv1lle (16 September 2008)

Oh I see what you mean - sorry O_B I thought you meant the shoeing might be causing it  
	
	
		
		
	


	




  Will definately ask the vet if we should do anything to the shoeing.


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## glenruby (16 September 2008)

If yourhorase has the beginnings of spavin (osteoarthritis of the hock) then until there is complete fusion of the distal hock joints, there will be some inflammation and unsoundness.
treating OA is a multpronged approach. 
1 Reduce inflammation
2 Improve lubrication
3 Aid fusion of the distal tarsal joints(arthrodesis)
Cortisone injections ( Depo-medrol is the longest lasting) can have a good effect and as long as you have had a proper lameness exam and radiographs taken (and you have), then this is probably the best route to go down.
Those who are against hock injections - why is this? Do you not agree with their use in arthritic horses who have had a full vet work up or is it the average jumper whose rider decides he needs hock injections just because - without any radiographic indications or without a full lameness exam?
There is definitely a problem if you start using them in non-arthritic horses as you are starting a cycle of hock injections that will last the rest of your horse's useful life. Corticosteroids are reported to have a degenerative effect on articular cartilage meaning that over time these injections can destroy the cartilage of the hock joints. However, OA (and inflammation) has a degenerative effect on the same cartilage - probably much stronger.  
Basically, in an arthritic horse, steroids will provide a strong anti-inflammatory effect and should improve his comfort and the HA will help lubricate his joints. 
You cant "mend" cartilage, but by reducing inflammation you can slow down its degenaration. This is effect means that corticosteroids could be both chondro-protective especially in the presence of HA, and chondro-destructive.

Personally, following a full lameness exam and radiographs I would use Depo0medrol(Triamcinolone is shorter acting) intra-articularly. The spacing between these injections should be greater than 6mths to start with but usually decrease over time. Once they last less than 2mths each time, more radiographs should be taken and surgical or laser arthrodesis should be considered.
Also do start using a supplement such as Cosequin or Cortaflex. Sometimes, when there's a lot of inflammation (ie early stages) shockwave therapy can be useful. Im not sure if diclofenac sodium (Surpass cream) is legal in the UK (it isnt in Ireland) but its a popular topical anitinflammatory in the US.
Good shoeing is vital, but there are lots of conflicting ideas on whats best as treatment for OA. Wedge heels and lateral extensions will speed up the fusion process by increasing movement in those joints. 
For maintenace at early stages I would recommend rolling the toe and placing eggbar shoes. Balanced feet is the most important thing.

Sorry this is a bit mixed up, Im literally writing it as it comes into my head.


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## melv1lle (17 September 2008)

No thank you thank you this is very helpful - you have put my mind at rest completely which is good as the vet is coming this morning  
	
	
		
		
	


	




  He had said that he will be using depo-medrol so fingers crossed.


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## TarrSteps (17 September 2008)

You've had a super answer from glenruby with all the info you need.

Just to add my experience, as mentioned above injecting hocks is almost "standard practice" in North America and I suspect that might be where some of the bad press has come from.  I think in at least some cases people do it "just because" if there is anything even remotely suspicious on the x-rays but then are disappointed when the horse isn't magically fixed even though there may be more/different factors in play.  Also, it used to be standard practice to inject huge amounts of cortisone alone just to make the horse sound.  However this is not how it's generally done anymore and it's considered to be a very crude, old fashioned approach.  

As glenruby so succinctly states, once the process has begun it's going to continue.  There is no way to reverse the damage, what you are doing is controlling the process as much as possible and managing the horse's discomfort.  Obviously this is part of a larger program, not just a "give it a shot and it's all better" approach.  

I had the interesting experience of managing a barn that contained a large number of ex-jumping horses (it was a school of sorts, but almost entirely "staffed" by retired show horses) many of whom had hock problems.  We managed them very carefully and individually and the vast majority stayed sound working 6 days a week and jumping regularly up to about 3'.  We used supportive shoeing, supplements, injections, meds, physio, managed workloads etc in whatever combination the individual horse needed and found that the best situation by far.  They didn't all respond the same way to the same things, or even the same way as they progressed.  There is always a bit of art with the science.

One thing I would say is after your horse is injected and starts on his program monitor him very carefully.  I found I could tell when horses needed injecting again by taking note of very subtle signs - one horse would start to speed up on landing, one would start to "skip" her changes - and get them done asap, hopefully lessening the degenerative process and certainly making the horse more comfortable.  I also did find with very careful management I could get the longest possible gap between injections, again, hopefully slowing the process down.  

Many of these horses were in their late teens/early twenties at the point I knew them - some had been "managed" for a decade or more - and when the business was closed most continued on as hacks/light riding horses so we must have been doing something right.

The fact is, once the breakdown starts you are never going to turn the clock back.  Avoiding treatment doesn't seem the most sensible plan (and this from someone generally less inclined to treat aggressively than most) as all you're doing is ignoring what's going on under the surface.  But it is important to remember it's management, not cure, so has to be kept up in order to keep the horse comfortable and functional.  

Best of luck with it.


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## ProperBo (17 September 2008)

my horse has had them twice and he was LOADS better !! hes on synoquin daily. Id def do the injections but you need a supplement too.


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