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High and Low Ringbone (Interphalangeal Joint Arthritis) in Horses

Published on
Last updated on
6 min read

Key takeaways


Ringbone refers to ring-shaped bony protrusions formed due to osteoarthritis in either the pastern joint or coffin joint in horses.

  • High ringbone involves the pastern joint. Low ringbone affects the coffin joint
  • Symptoms include lameness, pain, and if advanced, visible, firm protrusions around the pastern
  • Development of ringbone is linked to irregular conformation, injury, ongoing stresses incurred in certain sporting activities, or work on hard surfaces
  • Physical examination, flexion tests, nerve blocking, and diagnostic imaging are used to confirm diagnosis
  • Treatment aims to mitigate clinical symptoms through pain medications, joint care, and adjustments to shoeing
  • The prognosis for high ringbone is good, however chronic lameness commonly develops over time, resulting in retirement from athletic work
  • Low ringbone is difficult to treat and the prognosis is poor
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A closer look: High and Low Ringbone (Interphalangeal Joint Arthritis) in Horses


Ringbone is a common symptom in horses, especially those used for sport or work. It is a progressive disease that affects one or more limbs, most often the forelimbs.

Ringbone results from stress on the joints. Stress creates an inflammatory reaction in or around the joint. Inflammation releases toxins that continue to damage the tissue and dilute the joint fluid, which results in cartilage loss. New bone forms to stabilize the joint. These bony protrusions rub against each other and the other structures of the joint, causing damage, disability and pain.

Ringbone is either articular (within the joint) or periarticular (within the structures that support the joint). In cases where ringbone is periarticular, as long as the horse remains sound and the structures around the joint are undamaged, ringbone requires no treatment.

In cases where ringbone is articular, particularly when the coffin joint is involved, it can permanently lame the horse. In some cases, ringbone curtails the activities a horse can perform.

Risk factors


Once symptoms such as lameness and visible bony protrusions have developed, it is usually too late to reverse. Horses showing signs of mild lameness require prompt veterinary assessment to identify the underlying cause and prevent further structural damage. With appropriate management, most horses can be kept comfortable for light to moderate work. Over time, the progressive changes reduce the horse’s soundness, ultimately resulting in chronic lameness and retirement.

Ringbone is progressive, even with proper management. Over time, it can lame the horse beyond recovery. In some cases, pain and disability are unmanageable and euthanasia is the most humane option.

Possible causes


The instigating causes of ringbone are not always known. In some cases, injury or overuse causes damage to the joint. In other cases, an infection or developmental orthopedic disorders, including osteochondritis dissecans, are the cause. Lifestyle factors identified in the development of ringbone include:

  • Sports involving quick turning or abrupt stopping, such as jumping, reining, polo, roping, or barrel racing
  • Working on hard surfaces, such as roads
  • Upright pastern conformation
  • Degenerative changes associated with aging
  • Improper shoeing or trimming

Main symptoms


Testing and diagnosis


Since early detection is critical to improving long-term outcomes, veterinary attention is required for horses suspected of suffering from ringbone.

Diagnostic tools include:

  • Physical exam
  • Regional nerve or intra-articular block to identify the afflicted joint
  • Diagnostic imaging, including X-ray, ultrasound, bone scan, or MRI

Steps to Recovery


There is no cure for ringbone. Treatment aims to mitigate the progression of the disease and to ease clinical signs. Strategies include:

  • Anti-inflammatory medication
  • Joint injections for low ringbone
  • Joint health support medications
  • Bone-remodeling medications
  • Biologic injections
  • Changes to shoeing or trimming to support the joint
  • Nutraceuticals to support joint health
  • Alternative therapies, such as acupuncture and chiropractic
  • Light, consistent exercise to maintain joint mobility

In the case of low ringbone, joint fusion (ankylosis) may occur naturally after the disease has progressed sufficiently. In the case of high ringbone, surgical fusion (arthrodesis) or chemical fusion are possible. Surgical fusion immobilizes the joint with a combination of screws and plates. This procedure offers the possibility of complete recovery and even a return to work or sport. Chemical fusion immobilizes the joint via the injection of a caustic substance. This substance accelerates the deterioration of the cartilage and fuses the bone surfaces. This treatment is less invasive and expensive, but surgery generally has better outcomes. Contamination of surrounding tissues is possible with chemical methods.

Ringbone is incurable and progressive. Most horses can be kept comfortable for light riding or a reduced workload. Horses suffering from advanced ringbone may need to retire from sport or work life. In some cases, horses with ringbone can no longer withstand being ridden.

Prevention


There are no proven preventative measures to avoid ringbone. It is possible that proper hoof balance, shoeing and trimming are important for long-term joint health. Some sources suggest avoiding heavy work or work on hard surfaces, and adequately warming up prior to strenuous exercise are beneficial to preventing ringbone.

Is High and Low Ringbone (Interphalangeal Joint Arthritis) in Horses common?


Ringbone is a common complaint for all types of horses. Horses involved in sporting activities that require quick turns or abrupt stops are especially susceptible to ringbone. Horses who work on hard surfaces, like carriage horses or police mounts, as well as older horses, horses with irregular conformation, or those that have been improperly shod, are also at risk.

Typical Treatment


  • Anti-inflammatory medications
  • Joint injections
  • Bone-remodeling medications
  • Biologics
  • Nutraceuticals
  • Acupuncture
  • Chiropractic
  • Shoeing and trimming adjustments
  • Retirement
  • Light, consistent exercise

References


Matthew T. Brokken , DVM, DACVS, DACVSMR - Writing for Merck Veterinary Manual
Diane E. Rice - Writing for The Horse
Les Sellnow - Writing for The Horse
HEATHER SMITH-THOMAS WITH LAURIE BONNER - Writing for EQUUS Magazine
Janice Posnikoff, DVM - Writing for Horse Illustrated
Timothy G. Eastman, DVM, DACVS, MPVM - Writing for Bay Area Equestrian Network
Carol Shwetz Dvm - Writing for Manitoba Co-operator
David Ramey - Writing for David Ramey, DVM

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