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Fusing hocks

From: Patricia

Dear Jessica, I have talked about this with my vet once, and although he is a very good vet, he is not much of a communicator with us humans. I plan to talk to him again when he comes back in a few weeks, and I'm hoping that you will be able to work your usual magic and help me understand the issue well enough to ask him the right questions. He's not a man who volunteers information, so if I don't ask the right questions, I won't get the answers I need. My problem is that I don't really understand what is happening with my horse.

My eight-year-old gelding was just diagnosed (physical symptoms confirmed by X-ray) with arthritis of the hocks. I was devastated, as we are just starting to get somewhere with our dressage. Coley had been doing so well. Now I'm extremely confused about what I should do with him now, and what I should do with him over the next four or six or however many months (I don't know that either) it takes for his hocks to "fuse". Okay, and that's the next question. What exactly does "fusing" mean and what does it mean for his future as a dressage horse? From the way the vet was talking, it sounded like the bones would fuse together. But it seems to me that either a horse with fused hocks wouldn't be a riding horse anymore, or at least he wouldn't be a dressage horse anymore, because dressage horses have to be able to flex their hocks. So is this the end of Coley's career as a dressage horse, or even as a riding horse? My vet said "Go on riding, it'll help the fusion", but should we be helping it or trying to prevent it, or did he mean that it's already too late and there's no way to prevent it? And, will I be able to do any dressage at all with Coley, or will he never get past 1st Level? And will I have to medicate him to make him comfortable enough to compete? I don't believe in drugging horses so that you can ride them. Please help! As you can see I don't know enough to talk to my vet and get the information I need. If you explain it to me, I know I will be able to make sense to the vet and find out what I can and can't do with Coley and what I can expect. What upsets me more than anything else is that the vet mentioned "arthritis", and I don't know whether this means that Coley has arthritis now, or will be developing it if his hocks fuse, or will develop it if they don't fuse! But my Dad has arthritis and he's in pain most of the time. I couldn't go on riding a horse if it was in as much pain as my Dad is. Please, please help me. Your loyal fan since 1996, Patricia


Hi Patricia! You'll find some information on this subject in the HORSE-SENSE archives, but I don't mind tackling this question again.

First, stop worrying. Your vet may not be very communicative, but it sounds as though he knows what he's doing. Coley DOES have arthritis, right now. That's why his hocks are fusing. This is a "bad news, good news" situation, so don't panic.

Arthritis is a degenerative process, and what has happened with your horse's hocks is that the lower bones are experiencing an erosion of the protective cartilage that would normally keep bone surfaces from touching one another. As the cartilage wears away, the bones begin to rub against one another, and eventually enough new bone forms to "fuse" the two surfaces together. When this happens, there is no more inflammation and no more pain for the horse.

The hock joint is very special. It has a stack of small bones in it, and the ones that are most commonly affected by arthritis are the lower ones (lower tarsal bones). These are the bones that tend to lose their cartilage and then fuse together. This process is painful while it goes on, but once it's over, the horse is comfortable AND FUNCTIONAL. That's the good news - you're right that the hocks must be able to flex, but Coley's hocks will be able to flex even after his hocks fuse, because the lower tarsal bones (remember, these are the only ones that are fusing) are not involved, and were never involved, in hock flexion.

Depending on the degree of cartilage degeneration present, your vet may choose to use several different forms of treatment. The most common treatment nowadays involves chondroitin sulfate (ask about Adequan); your vet may also suggest injecting the joints, usually with Hyaluronic acid, sometimes with steroids. Or he may advise against this: Some vets prefer not to do any joint injections at all, because any joint injection is invasive and could result in an infection. If he does suggest injections, this is how they work: The steroids (typically cortisone) injections serve to reduce the inflammation, allowing the horse to move more comfortably. The steroids also simultaneously contribute to the further destruction of cartilage, thus tending to speed up the process of fusion.

Whether this hurts or helps the horse depends entirely on how the horse is managed and ridden. If the horse is being ridden gently and slowly, walking and trotting on straight lines and large figures (no cantering, no jumping, no tight turns), the exercise will help keep the horse fit while encouraging the fusion to proceed as quickly as possible. If the horse is being worked hard, asked to canter or gallop or perform small, intricate ring figures or tight turns, the exercise can cause even more damage. That's unlikely to be the case with Coley - you won't do those things with him. However, it's unfortunately something that happens all too often in the racing industry, where horses with hock trouble are often injected in an effort to get "one more race", with no regard to the long-term soundness of the animal.

Be patient, keep Coley moving as correctly as possible, and don't ask too much of him - and eventually those lower tarsal bones will fuse, Coley's pain will go away, and you'll be able to resume your training program and move up through the levels. Fused hocks - once they've finished fusing - shouldn't interfere with your plans. There are many horses with "fused hocks" performing well at Second Level and up.

I hope this gives you enough information to help you talk to your vet. Ask him questions, wait for the answers, and if you don't get enough of an answer, keep rephrasing the questions and asking additional questions until you feel that you and your vet understand each other. Good vets never mind how many questions you ask, as long as they know you are actively listening to the answers.

Jessica

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