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Ringbone is degenerative (unless it is caused by direct trauma). Treatment works to slow down the progress of the bony changes and alleviate the horse's pain, rather than working to cure it.
Shoeing: The farrier should balance the hoof and apply a shoe that supports the heels and allows for an easy breakover.
NSAIDs: or non-steroidal anti-inflammatory drugs help to alleviate the pain and reduce inflammation within and around the joints. Often NSAIDs make the horse comfortable enough to continue ridden work, which is good for the horse's overall health.
Joint injections: The pastern joint can be injected directly, typically with a form of corticosteroid and hyaluronic acid.
Extracorporeal shockwave therapy: A high intensity specialized percussion device can help to remodel new bone tissue and decrease pain.
Arthrodesis: the fusion of the two bones of the pastern joints eliminates the instability of the joint, and thus the inflammation. This procedure may then eliminate the horse's lameness as well. However, surgical alteration of the joint can promote the growth of bone in the area, which is cosmetically displeasing. Arthrodesis of the coffin joint is usually not performed due to the location of the joint (within the hoof) and because the coffin joint needs some mobility for the horse to move correctly (unlike the pastern joint, which is very still).
Interleukin-1 receptor antagonist protein (IRAP) blocks IL-1 from binding to tissues and inhibits the damaging consequences of IL-1.
Microcurrent technology: Tissue, including muscle, tendons, ligaments, skin and bone, is formed from a large mass of similar cells that perform specific functions. These cells use tiny sequences of electric current, measured in millionths of an amp, to organise, monitor and regulate a stable state within the body.
When there is injury, damage or disease to a tissue, there is disruption to the normal electrical current within the cells and things fail to work properly. By introducing the correct sequences the body's natural electric circuitry is replicated and kick starts and accelerates normal functioning.
If the ringbone is close to a joint, the prognosis for the horse's continued athletic use is not as good as if the ringbone is not near a joint. Ringbone that is progressing rapidly has a poorer prognosis as well.
Horses that are not performing strenuous work, such as jumping or working at speed, will probably be usable for years to come. However, horses competing in intense sports may not be able to continue at their previous level, as their pastern joints are constantly stressed.
Appropriate treatment for lameness depends on the condition diagnosed, but at a minimum it usually includes rest or decreased activity and anti-inflammatory medications. Other treatment options, such as corrective shoeing, joint injections, and regenerative therapies, are pursued based on the cause of lameness and the financial limits of the owner. Consultation with a veterinarian is generally recommended, even for mild cases, as some types of lameness may worsen if not properly diagnosed and treated.
Nerve blocks involve injecting a small amount of local anesthetic around a nerve or into a synovial structure (such as a joint or tendon sheath) in order to block the perception of pain in a specific area. After the substance is injected, it is given a few minutes to take effect. The block is then tested by pushing a blunt object, such as a ballpoint pen, into the area that is supposed to be desensitized. If the horse does not react to this pressure, the area is desensitized, and the horse is trotted to see if the lameness has improved. Improvement indicates that the cause of lameness was from a structure desensitized by the nerve block.
Nerve blocks are performed in a step-wise fashion, beginning at the most distal (lower) part of the limb and moving upward. This is due to the fact that blocking a nerve higher up will desensitize everything it innervates distal to the blocking location. For example, blocking the leg at the level of the fetlock will also block the entire foot, since the nerve fibers that innervate the foot are inhibited when they travel through the fetlock area. A positive result from this block will not be able to differentiate foot pain from pain in the pastern or fetlock region. More information may be gained from blocking the foot first, then the fetlock, since it allows for greater specificity in determining the cause of lameness.
The duration of the anesthetic varies depending on the substance used. Lidocaine is especially short acting, and is therefore usually not used for lameness evaluations. The longer-acting anesthetic mepivacaine is most-commonly used for nerve blocks, because ideally the block should last throughout the lameness exam to avoid false positives with subsequent blocks as they are performed up the leg. Bupivicaine is very long-lasting (up to 4–6 hours), and is most commonly used for analgesia following surgery rather than for nerve blocks.
Although nerve blocks are very important to the lameness examination, they are not foolproof. Multiple studies have shown that the anesthetic can migrate, especially if the horse is evaluated long after blocking or if a large amount of anesthetic is used. If the anesthetic migrates to the structure that is causing the horse pain, the horse will have a positive block, and the examiner will conclude that the lameness originates in an area that is not actually causing the horse discomfort. False results can also be secondary to practitioner error if the anesthetic is accidentally administered into a location that was unintended, such as a synovial structure rather than around a nerve. Additionally, individual horses have variation in their neural anatomy, and if atypical patterns are present, a given block may block an area unintended by the examiner, leading to false positives. Joints present additional problems. A large volume of anesthetic placed into a joint can diffuse out over time, blocking the surrounding structures. Additionally, there are some cases where joint pain can respond better to perineural blocking rather than blocking of the joint.